Provider Demographics
NPI:1558536870
Name:RACINE, CYNTHIA LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEA
Last Name:RACINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLY PLACE
Mailing Address - Street 2:DEPARTMENT OF VA MEDICAL CENTER PM&R ROOM 2-403
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:718-630-2983
Practice Address - Street 1:800 POLY PLACE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:718-630-2983
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY243686390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program