Provider Demographics
NPI:1518019900
Name:RABY, WILFRID NOEL (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRID
Middle Name:NOEL
Last Name:RABY
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4525 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 304
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3808
Mailing Address - Country:US
Mailing Address - Phone:718-884-1315
Mailing Address - Fax:212-568-3832
Practice Address - Street 1:175 CEDAR LN
Practice Address - Street 2:SUITE 7
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4315
Practice Address - Country:US
Practice Address - Phone:201-801-0052
Practice Address - Fax:212-568-3832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA661232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001023Medicare ID - Type Unspecified
NYG58336Medicare UPIN