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NPI Code Detail

MEDICARE: DR. SALLY A. MRAVCAK M.D.

MEDICARE: DR. SALLY A. MRAVCAK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25MA07499300NJ

General Provider Information

NPI Number : 1811009657
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SALLY A. MRAVCAK M.D.
Provider Business Mailing Address
First Line : 271 GROVE AVE STE E
Second Line :
City : VERONA
State : NJ
Zip : 07044-1730
Country : US
Telephone Number : 973-559-3700
Fax Number : 833-484-1686
Provider Business Practice Location Address
First Line : 271 GROVE AVE STE A
Second Line :
City : VERONA
State : NJ
Zip : 07044-1731
Country : US
Telephone Number : 973-239-2600
Fax Number : 833-495-1921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/16/2026

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