Provider Demographics
NPI:1932644630
Name:RAAD, ELAINE S
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:S
Last Name:RAAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2605
Mailing Address - Country:US
Mailing Address - Phone:239-266-4473
Mailing Address - Fax:
Practice Address - Street 1:2814 ROUTE 20
Practice Address - Street 2:
Practice Address - City:CORNWALLVILLE
Practice Address - State:NY
Practice Address - Zip Code:12418-0117
Practice Address - Country:US
Practice Address - Phone:518-239-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5226155164W00000X
NY317253164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse