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General NPI Number Information
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NPI Number | 1487797528
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Entity Type | Organization
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Legal Business Name | JOSEPH R. RACCUGLIA, MD, LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 12/09/2007
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Provider Practice Location Address
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Address Line | 4251 US HIGHWAY 9 SUITE 3-A
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City | FREEHOLD
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State | NJ
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Zip | 07728-8303
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Country | US
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Telephone | 732-780-3744
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Fax | 732-780-9644
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Provider Business Mailing Address
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Address Line | 10 OSSENER DR
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City | PERRINEVILLE
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State | NJ
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Zip | 08535-1032
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Country | US
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Telephone | 732-780-3744
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Fax | 732-780-9644
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH R RACCUGLIA
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Credential | MD
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Telephone | 732-780-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA06096200
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License Number State | NJ
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