Healthcare Provider Details

I. General information

NPI: 1467832980
Provider Name (Legal Business Name): JUSTIN ANDREW RAPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TURNPIKE NASSAU UNIVERSITY MEDICAL CENTER DEPARTMENT OF MEDICINE
EAST MEADOW NJ
11554
US

IV. Provider business mailing address

2201 HEMPSTEAD TURNPIKE NASSAU UNIVERSITY MEDICAL CENTER DEPARTMENT OF MEDICINE
EAST MEADOW NJ
11554
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6501
  • Fax:
Mailing address:
  • Phone: 516-572-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: