Provider Demographics
NPI:1740217108
Name:RAYMOND J. NISI,MD,PC
Entity Type:Organization
Organization Name:RAYMOND J. NISI,MD,PC
Other - Org Name:HUTCHISON METRO EYE SURGEONS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-904-9000
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-904-9000
Mailing Address - Fax:718-904-8610
Practice Address - Street 1:1200 WATERS PLACE
Practice Address - Street 2:SUITE M101 / NORTH LOBBY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2729
Practice Address - Country:US
Practice Address - Phone:718-904-9000
Practice Address - Fax:718-904-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01851289Medicaid
NY62F091Medicare ID - Type Unspecified
NY01851289Medicaid