Provider Demographics
NPI:1023444924
Name:VICKI RAAB MD LLC
Entity type:Organization
Organization Name:VICKI RAAB MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-663-1161
Mailing Address - Street 1:1405 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3532
Mailing Address - Country:US
Mailing Address - Phone:732-663-1161
Mailing Address - Fax:732-663-1164
Practice Address - Street 1:1405 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3532
Practice Address - Country:US
Practice Address - Phone:732-663-1161
Practice Address - Fax:732-663-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053261002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085075Medicare UPIN