Provider Demographics
NPI:1699903914
Name:RAFFAELE ALBANESE MD PA
Entity type:Organization
Organization Name:RAFFAELE ALBANESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFAELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-625-4666
Mailing Address - Street 1:16 POCONO RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-625-4666
Mailing Address - Fax:973-586-1606
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-625-4666
Practice Address - Fax:973-586-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02765900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2936801Medicaid
NJ2936801Medicaid