Healthcare Provider Details

I. General information

NPI: 1407995830
Provider Name (Legal Business Name): ALEX J RAI PH.D., DABCC, FACB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE 312BH
NEW YORK NY
10021-6007
US

IV. Provider business mailing address

6040 KENNEDY BLVD E APT. 15H
WEST NEW YORK NJ
07093-3825
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-5599
  • Fax:
Mailing address:
  • Phone: 212-639-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License NumberRAIXA1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: