Provider Demographics
NPI:1164482097
Name:OKLANDER, RAISA (DO)
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:OKLANDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:917-865-8482
Mailing Address - Fax:
Practice Address - Street 1:1720E 14TH ST M-2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2088
Practice Address - Country:US
Practice Address - Phone:718-368-3333
Practice Address - Fax:718-934-4885
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5998563OtherGHI
NY02046528Medicaid
5998563OtherGHI
H10622Medicare UPIN