Provider Demographics
NPI:1821310277
Name:RAYN HEALTHCARE ALLIANCE IPA, LLC
Entity Type:Organization
Organization Name:RAYN HEALTHCARE ALLIANCE IPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FARRUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-458-7898
Mailing Address - Street 1:1979 MARCUS AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1076
Mailing Address - Country:US
Mailing Address - Phone:516-622-2326
Mailing Address - Fax:516-452-5840
Practice Address - Street 1:1979 MARCUS AVE
Practice Address - Street 2:STE 210
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1076
Practice Address - Country:US
Practice Address - Phone:516-622-2326
Practice Address - Fax:516-452-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization