Healthcare Provider Details

I. General information

NPI: 1255610507
Provider Name (Legal Business Name): RAFFAELLA LINDA KALISHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CEDAR CREST VILLAGE DR
POMPTON PLAINS NJ
07444-2100
US

IV. Provider business mailing address

85 HARRISTOWN RD FL 2
GLEN ROCK NJ
07452-3329
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-3540
  • Fax: 973-831-3503
Mailing address:
  • Phone: 201-703-5500
  • Fax: 201-510-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA09457600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09457600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: