Provider Demographics
NPI:1548286081
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:718-351-2192
Mailing Address - Street 1:1870 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2553
Mailing Address - Country:US
Mailing Address - Phone:718-351-2192
Mailing Address - Fax:718-980-6012
Practice Address - Street 1:1870 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2553
Practice Address - Country:US
Practice Address - Phone:718-351-2192
Practice Address - Fax:718-980-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208100000X, 207U00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW012Medicare PIN
NYWBW011Medicare PIN