Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 25MA07108800 | NJ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD070216L | PA |
NPI | 1265487623 |
---|---|
Provider Name | Steven Mark Raikin |
First Address | Philadelphia, PA 19107-4404 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0559350000 | IBC (01) | PA |
0803514000 | IBC (01) | NJ |
2265820 | AETNA (01) | PA |
2378279 | AETNA (01) | NJ |
2784525 | CIGNA (01) | |
G85085 | (02) |