Provider Demographics
NPI:1629489166
Name:TSVAYGENBAUM, RAISA
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:TSVAYGENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 VICTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209
Mailing Address - Country:US
Mailing Address - Phone:518-248-7906
Mailing Address - Fax:
Practice Address - Street 1:1561 RTE 9W
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-339-1197
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006874-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery