Healthcare Provider Details

I. General information

NPI: 1912934829
Provider Name (Legal Business Name): DIONYSIA MAMAIS-RAPTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

4402 FRANCIS LEWIS BLVD
BAYSIDE NY
11361-3038
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2777
  • Fax:
Mailing address:
  • Phone: 718-631-0500
  • Fax: 718-281-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231406
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number231406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: