=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649158502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIPUL MEDICAL P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3692 BEDFORD AVE APT 6C
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-575-9917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2579 E 17TH ST STE 58
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-575-9917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAULINE RAITSES
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 609-575-9917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------