Provider Demographics
NPI:1730512443
Name:RAPHA MEDICAL GROUP PC
Entity type:Organization
Organization Name:RAPHA MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:AIGBOVBIOISE
Authorized Official - Last Name:UNUIGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-457-1415
Mailing Address - Street 1:4622 BLACK HORSE PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330
Mailing Address - Country:US
Mailing Address - Phone:609-705-8143
Mailing Address - Fax:609-837-0144
Practice Address - Street 1:4622 BLACK HORSE PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-705-8143
Practice Address - Fax:609-837-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care