Provider Demographics
NPI:1073679155
Name:PORZIO, RAYMOND CARL (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CARL
Last Name:PORZIO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2020
Mailing Address - Country:US
Mailing Address - Phone:631-331-5546
Mailing Address - Fax:
Practice Address - Street 1:331 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2020
Practice Address - Country:US
Practice Address - Phone:631-331-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4330156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician