Provider Demographics
NPI:1992738355
Name:RAIZES, GARY S (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:RAIZES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:259 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4523
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-722-9185
Practice Address - Street 1:600 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1635
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1928
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2018-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY135258207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00563328Medicaid
NYB13692Medicare UPIN
NY356311Medicare ID - Type Unspecified