Provider Demographics
NPI:1700851474
Name:RAITERI, ANTHONY VALENTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VALENTINE
Last Name:RAITERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W 19TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4216
Mailing Address - Country:US
Mailing Address - Phone:212-213-2853
Mailing Address - Fax:
Practice Address - Street 1:5 W 19TH ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4216
Practice Address - Country:US
Practice Address - Phone:212-213-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218522-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673623Medicaid
H77904Medicare UPIN
NY02673623Medicaid