Provider Demographics
NPI:1770501421
Name:MORETTI & RACCO MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MORETTI & RACCO MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-745-2442
Mailing Address - Street 1:7513 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2305
Mailing Address - Country:US
Mailing Address - Phone:718-745-2442
Mailing Address - Fax:718-745-2872
Practice Address - Street 1:7513 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2305
Practice Address - Country:US
Practice Address - Phone:718-745-2442
Practice Address - Fax:718-745-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206442207R00000X
NY227515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW012Medicare ID - Type Unspecified