Healthcare Provider Details

I. General information

NPI: 1801627187
Provider Name (Legal Business Name): ALICE RAIMONDI MSN, FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 NORTHERN BLVD STE 330
MANHASSET NY
11030-3043
US

IV. Provider business mailing address

146 DIAMOND AVE
EAST MEADOW NY
11554-3401
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-4330
  • Fax:
Mailing address:
  • Phone: 516-477-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: