Healthcare Provider Details

I. General information

NPI: 1124177969
Provider Name (Legal Business Name): MS. MARY RAGAZZO REILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 LINCOLN AVE E
CRANFORD NJ
07016-6100
US

IV. Provider business mailing address

347 LINCOLN AVE E
CRANFORD NJ
07016-6100
US

V. Phone/Fax

Practice location:
  • Phone: 646-645-3446
  • Fax:
Mailing address:
  • Phone: 646-645-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: