Organization
LOUIS J PETRACCA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS J PETRACCA M.D. (OWNER)
(973) 429-9225
Entity
Organization
Contact information
Practice address
332 BLOOMFIELD AVE, BLOOMFIELD, NJ 07003-4806
(973) 429-9225
(973) 566-0973
Mailing address
332 BLOOMFIELD AVE, BLOOMFIELD, NJ 07003-4806
(973) 429-9225
(973) 566-0973
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25MA04021600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2002507
—
NJ
01
—
P635038
OXFORD HEALTH PLANS
NJ
Enumeration date
05/15/2012
Last updated
05/15/2012
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