Healthcare Provider Details

I. General information

NPI: 1306103122
Provider Name (Legal Business Name): INNA R RAYKHELGAUZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 BROADWAY FL 4
NEW YORK NY
10013-6023
US

IV. Provider business mailing address

501 SURF AVE APT. 22B
BROOKLYN NY
11224-3551
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: