Provider Demographics
NPI:1659995801
Name:RAOSEN, THEODORE NATHAN
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:NATHAN
Last Name:RAOSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PINEHURST AVE APT B61
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-8808
Mailing Address - Country:US
Mailing Address - Phone:646-554-9953
Mailing Address - Fax:
Practice Address - Street 1:128 PINEHURST AVE APT B61
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1755
Practice Address - Country:US
Practice Address - Phone:646-554-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist