Healthcare Provider Details

I. General information

NPI: 1073545521
Provider Name (Legal Business Name): DELIA RAPPAPORT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 MAIN STREET
HACKENSACK NJ
07601
US

IV. Provider business mailing address

885 MAIN STREET
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-3957
  • Fax: 201-487-3009
Mailing address:
  • Phone: 201-487-3957
  • Fax: 201-487-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA05625700
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier4574303
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: