Provider Demographics
NPI:1245505601
Name:RACKOVSKY, ORI AVRAHAM (MD)
Entity type:Individual
Prefix:MR
First Name:ORI
Middle Name:AVRAHAM
Last Name:RACKOVSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1130 MCBRIDE AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:973-812-1404
Practice Address - Street 1:468 PARISH DR STE 6
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-988-2100
Practice Address - Fax:973-952-6248
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10376500207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0633488Medicaid