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General NPI Number Information
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NPI Number | 1740549443
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Entity Type | Organization
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Legal Business Name | VALENTIN RAKSIN, O.D., PC
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 1823 AVENUE M
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City | BROOKLYN
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State | NY
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Zip | 11230-5308
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Country | US
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Telephone | 718-377-5649
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Fax |
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Provider Business Mailing Address
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Address Line | 426 DANBURY LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5116
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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 | VALENTIN RAKSIN
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Credential | OD
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Telephone | 718-377-5649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 27OA00578000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | TUV006253-1
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License Number State | NY
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