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General NPI Number Information
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NPI Number | 1750654745
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Entity Type | Organization
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Legal Business Name | RAYCO MEDICAL PLLC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 2035 LAKEVILLE RD SUITE 300
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1600
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Country | US
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Telephone | 516-492-3309
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Fax | 516-492-3299
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Provider Business Mailing Address
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Address Line | 2035 LAKEVILLE RD SUITE 300
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1600
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Country | US
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Telephone | 516-492-3309
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Fax | 516-492-3299
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAHAN S. ROOFEH
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Credential | M.D.
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Telephone | 516-492-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 123456789
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License Number State | NY
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