Healthcare Provider Details

I. General information

NPI: 1245505601
Provider Name (Legal Business Name): ORI AVRAHAM RACKOVSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 PARISH DR STE 6
WAYNE NJ
07470-4671
US

IV. Provider business mailing address

1130 MCBRIDE AVENUE 3RD FLOOR
WOODLAND PARK NJ
07424
US

V. Phone/Fax

Practice location:
  • Phone: 973-988-2100
  • Fax: 973-952-6248
Mailing address:
  • Phone: 973-812-1400
  • Fax: 973-812-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA10376500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: