Provider Demographics
NPI:1831272293
Name:RAYKHMAN, NATALIA (MD)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:RAYKHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 160TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1352
Mailing Address - Country:US
Mailing Address - Phone:718-746-3093
Mailing Address - Fax:718-746-2558
Practice Address - Street 1:915 160TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1352
Practice Address - Country:US
Practice Address - Phone:718-746-3093
Practice Address - Fax:718-746-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01609425Medicaid
NYE50311Medicare UPIN
NY01609425Medicaid