Healthcare Provider Details

I. General information

NPI: 1750960647
Provider Name (Legal Business Name): WARESH RAGHUBIR EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10445 111TH ST
SOUTH RICHMOND HILL NY
11419-2415
US

IV. Provider business mailing address

10445 111TH ST
SOUTH RICHMOND HILL NY
11419-2415
US

V. Phone/Fax

Practice location:
  • Phone: 917-396-6012
  • Fax:
Mailing address:
  • Phone: 917-396-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number464004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: