Provider Demographics
NPI:1154461986
Name:RAY, WILLIAM III (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:RAY
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6053
Mailing Address - Country:US
Mailing Address - Phone:631-467-5468
Mailing Address - Fax:631-467-5469
Practice Address - Street 1:879 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6053
Practice Address - Country:US
Practice Address - Phone:631-467-5468
Practice Address - Fax:631-467-5469
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO4182-4111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT86855Medicare UPIN
NYX23741Medicare ID - Type Unspecified