Provider Demographics
NPI:1952163347
Name:RABEN, ALEXANDER STEFAN
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:STEFAN
Last Name:RABEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 QUINTARD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4204
Mailing Address - Country:US
Mailing Address - Phone:917-392-0900
Mailing Address - Fax:
Practice Address - Street 1:365 QUINTARD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4204
Practice Address - Country:US
Practice Address - Phone:917-392-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist