Provider Demographics
NPI:1740444686
Name:MEDHAT RAOUF, M.D., P.A.
Entity type:Organization
Organization Name:MEDHAT RAOUF, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-962-4000
Mailing Address - Street 1:60 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2012
Mailing Address - Country:US
Mailing Address - Phone:973-962-4000
Mailing Address - Fax:
Practice Address - Street 1:60 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2012
Practice Address - Country:US
Practice Address - Phone:973-962-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA044564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520367Medicare PIN