Provider Demographics
NPI:1598711335
Name:DI MARTINO, RAYMOND NICHOLAS (RPH02/)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:NICHOLAS
Last Name:DI MARTINO
Suffix:
Gender:M
Credentials:RPH02/
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 186TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 1ST AVE
Practice Address - Street 2:RM. 123
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9102
Practice Address - Country:US
Practice Address - Phone:212-447-4936
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist