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General NPI Number Information
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NPI Number | 1386920601
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Entity Type | Organization
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Legal Business Name | SERVICES FOR PREFERRED MEDICAL PATIENTS, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 200 E ROUTE 59 SUITE 8
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City | NANUET
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State | NY
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Zip | 10954-2909
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Country | US
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Telephone | 845-507-0442
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Fax | 845-507-0501
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Provider Business Mailing Address
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Address Line | 200 E ROUTE 59 SUITE 8
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City | NANUET
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State | NY
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Zip | 10954-2909
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Country | US
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Telephone | 845-507-0442
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Fax | 845-507-0501
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Authorized Official
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Title or Position | MD
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Name | DR. CLOVIS RAYMOND
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Credential |
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Telephone | 561-324-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 253550
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License Number State | NY
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