Healthcare Provider Details

I. General information

NPI: 1275742850
Provider Name (Legal Business Name): YUSUF A RAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAFAYETTE AVE
STATEN ISLAND NY
10301-1219
US

IV. Provider business mailing address

14012 243RD ST
ROSEDALE NY
11422-2125
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-9000
  • Fax: 718-448-0105
Mailing address:
  • Phone: 917-653-4534
  • Fax: 718-448-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006333-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: