Provider Demographics
NPI:1255448742
Name:HARVEY, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HARVEY
Suffix:
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 1:1 FAMILY PRACTICE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6449
Mailing Address - Country:US
Mailing Address - Phone:845-338-6400
Mailing Address - Fax:845-339-7288
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:845-338-6400
Practice Address - Fax:845-339-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02156178Medicaid
NY33V8420581Medicare PIN
NY02156178Medicaid