Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 215452 | NY |
N | 207RG0300X | Geriatric Medicine | 61945 | NJ |
NPI | 1013948777 |
---|---|
Provider Name | Dr. Miriam Rachel Raport |
First Address | New York, NY 10011-6609 |
Second Address | New York, NY 10011-6609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02364583 | (05) | NY |
215452 | LICENSE (01) | NY |
61945 | LICENSE (01) | NJ |
G43553 | (02) | NY |