Healthcare Provider Details

I. General information

NPI: 1700916533
Provider Name (Legal Business Name): RAYMOND L. SOLETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 NORTHERN BLVD SUITE 201
MANHASSET NY
11030-3033
US

IV. Provider business mailing address

1615 NORTHERN BLVD SUITE 201
MANHASSET NY
11030-3033
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-7952
  • Fax: 516-365-7233
Mailing address:
  • Phone: 516-365-7952
  • Fax: 516-365-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND L SOLETIC
Title or Position: OWNER
Credential: MD
Phone: 516-365-7952