Healthcare Provider Details

I. General information

NPI: 1548286081
Provider Name (Legal Business Name): MORETTI & RACCO MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 RICHMOND RD
STATEN ISLAND NY
10306-2553
US

IV. Provider business mailing address

1870 RICHMOND RD
STATEN ISLAND NY
10306-2553
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-2192
  • Fax: 718-980-6012
Mailing address:
  • Phone: 718-351-2192
  • Fax: 718-980-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ALEX RACCO
Title or Position: OWNER
Credential: DO
Phone: 718-351-2192