Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 264631 | NY |
NPI | 1033364351 |
---|---|
Provider Name | Dr. Raymond Charles Sultan |
First Address | Manhasset, NY 11030-1974 |
Second Address | Manhasset, NY 11030-1974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CG0053 | RAILROAD MEDICARE (01) |