Provider Demographics
NPI:1881839462
Name:RAZGAITIS, ELLEN J (CNM)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:J
Last Name:RAZGAITIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5604
Mailing Address - Country:US
Mailing Address - Phone:718-788-5796
Mailing Address - Fax:718-788-5796
Practice Address - Street 1:1622 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5604
Practice Address - Country:US
Practice Address - Phone:718-788-5796
Practice Address - Fax:718-788-5796
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001326176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife