Healthcare Provider Details

I. General information

NPI: 1417453127
Provider Name (Legal Business Name): RACHEL GONNELLA GRACI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ANN GONNELLA M.D.

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH ST STE 200
MORRISTOWN NJ
07960-6471
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-822-0003
  • Fax: 973-822-3349
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11114300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: