Provider Demographics
NPI:1093075442
Name:SWIFT, RAYMOND CHARLES III (LPN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:SWIFT
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SYRACUSE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3626
Mailing Address - Country:US
Mailing Address - Phone:631-949-4790
Mailing Address - Fax:
Practice Address - Street 1:127 SYRACUSE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3626
Practice Address - Country:US
Practice Address - Phone:631-949-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health