Healthcare Provider Details

I. General information

NPI: 1447455795
Provider Name (Legal Business Name): RALUCA RADULESCU-MARINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 LINCOLN AVE STE 1
GLEN ROCK NJ
07452-3228
US

IV. Provider business mailing address

875 LINCOLN AVE STE 1
GLEN ROCK NJ
07452-3228
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-1990
  • Fax:
Mailing address:
  • Phone: 201-445-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA07742900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: