=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407949704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND SOLURI DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 04/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 MAIN ST
-----------------------------------------------------
City | FARMINGDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11735-3585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-249-0600
-----------------------------------------------------
Fax | 516-420-4032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 366 TIVOLI CIR
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-3876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-473-8152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | N004599
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------