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General NPI Number Information
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NPI Number | 1336453968
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Entity Type | Organization
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Legal Business Name | RAKLYAR MEDICAL PC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 260 E 66TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-9196
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Country | US
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Telephone | 212-593-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 E 1ST ST
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City | BROOKLYN
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State | NY
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Zip | 11223-5353
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDUARD RAKLYAR
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Credential | MD
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Telephone | 202-486-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 253090
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License Number State | NY
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