Provider Demographics
NPI:1699048918
Name:SULTAN, RAYMOND R (RPA-C)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:R
Last Name:SULTAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7104
Mailing Address - Country:US
Mailing Address - Phone:646-919-0757
Mailing Address - Fax:718-504-5409
Practice Address - Street 1:1562 E 14TH ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7104
Practice Address - Country:US
Practice Address - Phone:646-919-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant