=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063631950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIA RABER, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 MARCUS AVE
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-358-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2673 RACHEL ST
-----------------------------------------------------
City | BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-409-6462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JULIA RABER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-409-6462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 208379
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------