Provider Demographics
NPI:1700209202
Name:INDIG, RAIZY
Entity Type:Individual
Prefix:
First Name:RAIZY
Middle Name:
Last Name:INDIG
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 1:1 HAMASPIK WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-8452
Mailing Address - Country:US
Mailing Address - Phone:845-774-0337
Mailing Address - Fax:845-774-0537
Practice Address - Street 1:1 HAMASPIK WAY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-8452
Practice Address - Country:US
Practice Address - Phone:845-774-0337
Practice Address - Fax:845-774-0537
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator