Provider Demographics
NPI:1922180587
Name:RAYTSES, NATALYA (DO)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:RAYTSES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6514 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1856
Mailing Address - Country:US
Mailing Address - Phone:718-275-2912
Mailing Address - Fax:718-275-4564
Practice Address - Street 1:6514 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1856
Practice Address - Country:US
Practice Address - Phone:718-275-2912
Practice Address - Fax:718-275-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02077461Medicaid
NYY10010Medicare UPIN
NY02077461Medicaid