Provider Demographics
NPI:1215201546
Name:RAY, MAURICE MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:MICHAEL
Last Name:RAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4310
Mailing Address - Country:US
Mailing Address - Phone:914-729-0078
Mailing Address - Fax:
Practice Address - Street 1:4120 27TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3825
Practice Address - Country:US
Practice Address - Phone:718-784-2240
Practice Address - Fax:718-784-0240
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003061-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical