Provider Demographics
NPI:1114996477
Name:BARRAVECCHIO, ANTHONY J (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BARRAVECCHIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 HAMBURG TPKE
Mailing Address - Street 2:WAYNE COMMONS, SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2025
Mailing Address - Country:US
Mailing Address - Phone:973-942-6005
Mailing Address - Fax:973-942-6009
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:WAYNE COMMONS, SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-942-6005
Practice Address - Fax:973-942-6009
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06978600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7678228OtherAETNA PPO #
NJ1K8291OtherHEALTHNET #
NJ6R2921OtherEMPIRE BC/BS #
NJ080180176OtherRAILROAD MDCR #
NJ2016613000OtherAMERIHEALTH ID#
NJ2586866OtherAETNA HMO #
NJ8643903Medicaid
NJ5716972OtherGHI PPO #
NJP2010902OtherOXFORD ID#
NJ6R2921OtherEMPIRE BC/BS #
NJ2586866OtherAETNA HMO #