Provider Demographics
NPI:1033364351
Name:SULTAN, RAYMOND CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:SULTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1974
Mailing Address - Country:US
Mailing Address - Phone:516-627-6188
Mailing Address - Fax:516-627-9397
Practice Address - Street 1:535 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1974
Practice Address - Country:US
Practice Address - Phone:516-627-6188
Practice Address - Fax:516-627-9397
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264631208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG0053OtherRAILROAD MEDICARE
0566510001Medicare NSC
W2L951Medicare PIN