Provider Demographics
NPI:1508208745
Name:RACLAW, MINDY RUTH
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:RUTH
Last Name:RACLAW
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 1:6615 THORNTON PL APT 2N
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5125
Mailing Address - Country:US
Mailing Address - Phone:718-261-1138
Mailing Address - Fax:
Practice Address - Street 1:6615 THORNTON PL APT 2N
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5125
Practice Address - Country:US
Practice Address - Phone:718-261-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist