Provider Demographics
NPI:1407949704
Name:SOLURI, RAYMOND (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:SOLURI
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 1:366 TIVOLI CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3876
Mailing Address - Country:US
Mailing Address - Phone:516-473-8152
Mailing Address - Fax:
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3585
Practice Address - Country:US
Practice Address - Phone:516-249-0600
Practice Address - Fax:516-420-4032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004599213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01181819Medicaid
NYP52751Medicare ID - Type Unspecified
NYU18048Medicare UPIN