Healthcare Provider Details

I. General information

NPI: 1013961309
Provider Name (Legal Business Name): JOSEPH S RACCUIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE
HOBOKEN NJ
07030-3794
US

IV. Provider business mailing address

70A GREENWICH AVE BOX 101
NEW YORK NY
10011-8300
US

V. Phone/Fax

Practice location:
  • Phone: 917-349-0537
  • Fax: 646-952-7741
Mailing address:
  • Phone: 917-349-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number196145I
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA05542200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number196145I
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number125MA05542200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: