Provider Demographics
NPI:1598926057
Name:PADULA, RAYMOND J (RN)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:J
Last Name:PADULA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6536
Mailing Address - Country:US
Mailing Address - Phone:631-664-6519
Mailing Address - Fax:
Practice Address - Street 1:2132 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6536
Practice Address - Country:US
Practice Address - Phone:631-664-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331156-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331156-1Medicaid