MEDICARE: VALENTIN RAKSIN, O.D., PC

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	261QH0100X	Health Service Clinic/Center	27OA00578000	NJ
2	261QH0100X	Health Service Clinic/Center	TUV006253-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740549443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENTIN RAKSIN, O.D., PC

Provider Business Mailing Address
First Line	:	426 DANBURY LN
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5308
Country	:	US
Telephone Number	:	718-377-5649
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VALENTIN RAKSIN
Credential	:	OD
Telephone Number	:	718-377-5649

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	05/15/2012

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