MEDICARE: LYNN M RAIMO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F304932-1	NY

General Provider Information

NPI Number	:	1164670238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN M RAIMO NP

Provider Business Mailing Address
First Line	:	38 JAMES ST
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-2808
Country	:	US
Telephone Number	:	631-321-8337
Fax Number	:	631-321-9347

Provider Business Practice Location Address
First Line	:	38 JAMES ST
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-2808
Country	:	US
Telephone Number	:	631-321-8337
Fax Number	:	631-321-9347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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