Provider Demographics
NPI:1265848741
Name:RAYMOND, HENRIQUEZ JR
Entity Type:Individual
Prefix:
First Name:HENRIQUEZ
Middle Name:
Last Name:RAYMOND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 E 94TH ST
Mailing Address - Street 2:3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1641
Mailing Address - Country:US
Mailing Address - Phone:347-792-0740
Mailing Address - Fax:
Practice Address - Street 1:458 E 94TH ST
Practice Address - Street 2:3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1641
Practice Address - Country:US
Practice Address - Phone:347-792-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse