Provider Demographics
NPI:1932260643
Name:RAYMOND, ALAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:480 2ND AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9151
Mailing Address - Country:US
Mailing Address - Phone:212-683-9025
Mailing Address - Fax:212-683-9028
Practice Address - Street 1:480 2ND AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9151
Practice Address - Country:US
Practice Address - Phone:212-683-9028
Practice Address - Fax:212-683-9028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15D061207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00830222Medicaid
NY00830222Medicaid
NY15D061Medicare ID - Type Unspecified