Provider Demographics
NPI:1013961309
Name:RACCUIA, JOSEPH S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:RACCUIA
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 1:70A GREENWICH AVE
Mailing Address - Street 2:BOX 101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8300
Mailing Address - Country:US
Mailing Address - Phone:917-349-0537
Mailing Address - Fax:
Practice Address - Street 1:228 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3794
Practice Address - Country:US
Practice Address - Phone:917-349-0537
Practice Address - Fax:646-952-7741
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196145I208600000X, 2086X0206X
NJ25MA05542200208600000X
NJ125MA055422002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01608511Medicaid
NY01608511Medicaid
NJ651566Medicare PIN
NY12J741Medicare ID - Type Unspecified