Provider Demographics
NPI:1629161989
Name:RAPAPORT, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:RAPAPORT
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 1:333 SYLVAN AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2724
Mailing Address - Country:US
Mailing Address - Phone:201-227-1555
Mailing Address - Fax:201-227-8477
Practice Address - Street 1:333 SYLVAN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2724
Practice Address - Country:US
Practice Address - Phone:201-227-1555
Practice Address - Fax:201-227-8477
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04012900207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B18665Medicare UPIN