Provider Demographics
NPI:1376526145
Name:RASKIN, SIMON (DPM)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:RASKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4322
Mailing Address - Country:US
Mailing Address - Phone:718-332-7771
Mailing Address - Fax:718-332-1311
Practice Address - Street 1:1409 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4322
Practice Address - Country:US
Practice Address - Phone:718-332-7771
Practice Address - Fax:888-636-2212
Is Sole Proprietor?:No
Enumeration Date:2005-11-24
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005608213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPK5251OtherBLUE CROSS BLUE SHIELD
NY02195893Medicaid
NYPG3231Medicare ID - Type Unspecified
NY02195893Medicaid
NY5306770001Medicare NSC