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General NPI Number Information
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NPI Number | 1144197856
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Entity Type | Organization
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Legal Business Name | RACANELLI DERMATOLOGY LLC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 115 ROUTE 46 STE D25
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1658
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Country | US
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Telephone | 862-217-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 115 ROUTE 46 STE D25
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | JENNIFER RACANELLI
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Credential | DO
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Telephone | 862-217-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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