Provider Demographics
NPI:1952504979
Name:HOLYSPIRIT
Entity Type:Organization
Organization Name:HOLYSPIRIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AGHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-270-6834
Mailing Address - Street 1:117 WALDORF AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1522
Mailing Address - Country:US
Mailing Address - Phone:516-270-3852
Mailing Address - Fax:516-887-1235
Practice Address - Street 1:10 E MERRICK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5800
Practice Address - Country:US
Practice Address - Phone:516-270-6834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2393022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1790851939OtherINDIVIDUAL NPI