Provider Demographics
NPI:1144344623
Name:RAYEVSKY, IGOR G (MD)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:G
Last Name:RAYEVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 WINDING DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-429-0300
Mailing Address - Fax:856-429-0300
Practice Address - Street 1:1112 WINDING DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-429-0300
Practice Address - Fax:856-429-0300
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA045676002085R0001X
NY1685532085R0001X
PAMD05717012085R0001X
KY249812085R0001X
WV207052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ016403Medicaid
1519101Medicare ID - Type Unspecified
D90085Medicare UPIN