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General NPI Number Information
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NPI Number | 1821310277
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Entity Type | Organization
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Legal Business Name | RAYN HEALTHCARE ALLIANCE IPA, LLC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 1979 MARCUS AVE STE 210
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1076
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Country | US
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Telephone | 516-622-2326
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Fax | 516-452-5840
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Provider Business Mailing Address
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Address Line | 1979 MARCUS AVE STE 210
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1076
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Country | US
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Telephone | 516-622-2326
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Fax | 516-452-5840
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | FARRUKH KHWAJA
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Credential |
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Telephone | 516-458-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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