Provider Demographics
NPI:1538156989
Name:RASKIN, JONATHAN MARVIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARVIN
Last Name:RASKIN
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 1:1000 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0934
Mailing Address - Country:US
Mailing Address - Phone:212-288-4600
Mailing Address - Fax:212-861-4054
Practice Address - Street 1:1000 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0934
Practice Address - Country:US
Practice Address - Phone:212-288-4600
Practice Address - Fax:212-861-4054
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140099207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB87315Medicare UPIN
NY88A171Medicare ID - Type UnspecifiedPROVIDER #