MEDICARE: DR. VITALY RAYKHMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	208800000X	Urology Physician	220650	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386656361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VITALY RAYKHMAN M.D.

Provider Business Mailing Address
First Line	:	2632 E 14TH ST
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3916
Country	:	US
Telephone Number	:	718-375-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 E 14TH ST
Second Line	:	SUITE 101
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3916
Country	:	US
Telephone Number	:	718-375-2100
Fax Number	:	800-349-4298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	04/12/2026

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