Healthcare Provider Details

I. General information

NPI: 1053064188
Provider Name (Legal Business Name): RAQUEL CARINA GONCALVES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 STONE ST FL 1
RAHWAY NJ
07065-2742
US

IV. Provider business mailing address

865 STONE ST FL 1
RAHWAY NJ
07065-2742
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7636
  • Fax: 973-324-5257
Mailing address:
  • Phone: 732-499-6380
  • Fax: 732-680-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01125100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: