Provider Demographics
NPI:1588688303
Name:LONGOBARDI, RAPHAEL S (MD)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:S
Last Name:LONGOBARDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:3025 PARAMUS PARK MALL
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3550
Practice Address - Country:US
Practice Address - Phone:201-267-6898
Practice Address - Fax:201-267-6897
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA06397207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG02628Medicare UPIN