Provider Demographics
NPI:1558534289
Name:NATALYA RAYTSES MEDICAL PC
Entity Type:Organization
Organization Name:NATALYA RAYTSES MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYTSES
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DO
Authorized Official - Phone:718-275-2912
Mailing Address - Street 1:6514 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1856
Mailing Address - Country:US
Mailing Address - Phone:718-275-2912
Mailing Address - Fax:
Practice Address - Street 1:6514 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1856
Practice Address - Country:US
Practice Address - Phone:718-275-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02077461Medicaid
NY215157OtherLICENSE
NY06314Medicare PIN
NY215157OtherLICENSE