Provider Demographics
NPI:1891913141
Name:RAPHAEL OSHEROFF, M.D, P.A.
Entity Type:Organization
Organization Name:RAPHAEL OSHEROFF, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSHEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-928-2777
Mailing Address - Street 1:2 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2427
Mailing Address - Country:US
Mailing Address - Phone:973-928-2777
Mailing Address - Fax:973-928-2776
Practice Address - Street 1:385 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4035
Practice Address - Country:US
Practice Address - Phone:973-928-2777
Practice Address - Fax:973-928-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06156400208D00000X
NY175535-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6919600Medicaid
NJBO4332095OtherNJ DEA
NJB92715Medicare UPIN
NJ6919600Medicaid