Healthcare Provider Details

I. General information

NPI: 1992900138
Provider Name (Legal Business Name): RAYMOND S BACCI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 5TH AVE
BROOKLYN NY
11220-4609
US

IV. Provider business mailing address

2 CROSSWICKS RD
FREEHOLD NJ
07728-3009
US

V. Phone/Fax

Practice location:
  • Phone: 718-492-0900
  • Fax: 718-439-3738
Mailing address:
  • Phone: 732-577-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040086
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: