Healthcare Provider Details

I. General information

NPI: 1407915713
Provider Name (Legal Business Name): MRS. SONYA RAISHEVICH III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 KINGS HWY
BROOKLYN NY
11223-2336
US

IV. Provider business mailing address

937 KINGS HWY
BROOKLYN NY
11223-2336
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-0783
  • Fax: 718-336-7203
Mailing address:
  • Phone: 718-336-0783
  • Fax: 718-336-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberG72761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: