Provider Demographics
NPI:1912164401
Name:RAOUL G BINIAURISHVILI MD PC
Entity Type:Organization
Organization Name:RAOUL G BINIAURISHVILI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAOUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BINIAURISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:215-464-7820
Mailing Address - Street 1:170 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2322
Mailing Address - Country:US
Mailing Address - Phone:609-497-7576
Mailing Address - Fax:
Practice Address - Street 1:11685-C BUSTLETON AVE
Practice Address - Street 2:HENDRIX CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2542
Practice Address - Country:US
Practice Address - Phone:215-464-7820
Practice Address - Fax:215-464-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048245L2084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014094500003Medicaid
PA733403Medicare PIN
PA0014094500003Medicaid