Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 056-0000182 | VT |
Y | 222Z00000X | Podiatrist | 056-0000182 | VT |
N | 213E00000X | Podiatrist | 6420 | NY |
N | 222Z00000X | Podiatrist | 6420 | NY |
NPI | 1023313848 |
---|---|
Provider Name | Dr. Angela Mary Raimo |
First Address | Manhasset, NY 11030-3834 |
Second Address | South Burlington, VT 05403-6422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 07/10/2011 |