Provider Demographics
NPI:1376124859
Name:RAIA, DENA
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:RAIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3724
Mailing Address - Country:US
Mailing Address - Phone:631-484-5547
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE STE 310
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7560
Practice Address - Country:US
Practice Address - Phone:631-484-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other