Healthcare Provider Details

I. General information

NPI: 1407532104
Provider Name (Legal Business Name): RACQUEL JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 CLINTON AVE
IRVINGTON NJ
07111-1442
US

IV. Provider business mailing address

1375 CLINTON AVE
IRVINGTON NJ
07111-1442
US

V. Phone/Fax

Practice location:
  • Phone: 973-375-5575
  • Fax:
Mailing address:
  • Phone: 973-375-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12936200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number064765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: