Individual
LISA RAACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 PROSPECT AVE STE 613, HACKENSACK, NJ 07601-1962
(201) 336-8111
(201) 336-8445
Mailing address
20 PROSPECT AVE STE 613, HACKENSACK, NJ 07601-1962
(201) 336-8111
(201) 336-8445
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1677921
NY
207R00000X
Internal Medicine Physician
Primary
25MA08360000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01590596
—
NY
01
—
110166628
RR MEDICARE
NY
Enumeration date
02/23/2006
Last updated
02/25/2009
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