Provider Demographics
NPI:1073600748
Name:RAAB, VICKI E (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:E
Last Name:RAAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 STATE ROUTE 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 STATE ROUTE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053261002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF36438Medicare UPIN
NJRA085075Medicare ID - Type Unspecified