Basic Information
| Provider Information | |||||||||
| NPI: | 1518194349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAKICKAS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 ROUTE 130 N STE 1438 | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080773046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568290407 | ||||||||
| FaxNumber: | 8568290453 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 ROUTE 130 N STE 1438 | ||||||||
| Address2: | |||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080773046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568290407 | ||||||||
| FaxNumber: | 8568290453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA09125700 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.