Provider Demographics
NPI:1497814396
Name:AQUILA, RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:AQUILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 UPPER MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1905
Mailing Address - Country:US
Mailing Address - Phone:212-586-4773
Mailing Address - Fax:
Practice Address - Street 1:350A W 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7383
Practice Address - Country:US
Practice Address - Phone:212-586-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1785932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01605247Medicaid
NY01605247Medicaid
RA 015G8610Medicare ID - Type Unspecified