Provider Demographics
NPI:1568686897
Name:RAXLEN, BERNARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:DAVID
Last Name:RAXLEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:566 7TH AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1802
Mailing Address - Country:US
Mailing Address - Phone:212-799-1121
Mailing Address - Fax:212-799-2377
Practice Address - Street 1:566 7TH AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1802
Practice Address - Country:US
Practice Address - Phone:212-799-1121
Practice Address - Fax:212-799-2377
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY170256207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBR13038Medicare UPIN