Provider Demographics
NPI:1487797528
Name:JOSEPH R. RACCUGLIA, MD, LLC
Entity type:Organization
Organization Name:JOSEPH R. RACCUGLIA, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:RACCUGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-780-3744
Mailing Address - Street 1:10 OSSENER DR
Mailing Address - Street 2:
Mailing Address - City:PERRINEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-1032
Mailing Address - Country:US
Mailing Address - Phone:732-780-3744
Mailing Address - Fax:732-780-9644
Practice Address - Street 1:4251 US HIGHWAY 9
Practice Address - Street 2:SUITE 3-A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8303
Practice Address - Country:US
Practice Address - Phone:732-780-3744
Practice Address - Fax:732-780-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06096200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7201907Medicaid
NJ776484Medicare ID - Type Unspecified
NJ7201907Medicaid