MEDICARE: SIMON RASKIN DPM PC

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	213E00000X	Podiatrist	N005608	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
2	PK5251	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1609980192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMON RASKIN DPM PC

Provider Business Mailing Address
First Line	:	1409 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4322
Country	:	US
Telephone Number	:	718-332-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4322
Country	:	US
Telephone Number	:	718-332-7771
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SIMON RASKIN
Credential	:	DPM
Telephone Number	:	718-332-7771

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/18/2014

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