MEDICARE: CHENOA RASKIN

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	225200000X	Physical Therapy Assistant		NY

General Provider Information

NPI Number	:	1629777115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHENOA RASKIN

Provider Business Mailing Address
First Line	:	135 ASHLAND PL APT 12B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3956
Country	:	US
Telephone Number	:	917-387-5348
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6703
Country	:	US
Telephone Number	:	718-540-8009
Fax Number	:

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/23/2023

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Directions to “ CHENOA RASKIN ” Practice Location

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