1730728577 NPI number — LAUREN ELIZABETH RAY PT. DPT, CSCS

Table of content: LAUREN ELIZABETH RAY PT. DPT, CSCS (NPI 1730728577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730728577 NPI number — LAUREN ELIZABETH RAY PT. DPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
LAUREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT. DPT, CSCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730728577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 EAST 74TH STREET
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-752-8578
Provider Business Mailing Address Fax Number:
212-439-1608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 EAST 74TH STREET
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-439-1596
Provider Business Practice Location Address Fax Number:
212-439-1608
Provider Enumeration Date:
12/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  045393-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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