Provider Demographics
NPI:1972885101
Name:RAYMOND, FRANK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:RAYMOND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 MAIN ST
Mailing Address - Street 2:#206
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3132
Mailing Address - Country:US
Mailing Address - Phone:516-322-3819
Mailing Address - Fax:
Practice Address - Street 1:372 MAIN ST
Practice Address - Street 2:#206
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3132
Practice Address - Country:US
Practice Address - Phone:516-322-3819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01197906Medicaid
NY01197906Medicaid
NY60F051Medicare PIN