Basic Information
| Provider Information | |||||||||
| NPI: | 1144221144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAICHELSON | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 KENSICO DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105491009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146668866 | ||||||||
| FaxNumber: | 9146666777 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 N MIDLAND AVE | ||||||||
| Address2: | NYACK HOSPITAL | ||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109601912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453482862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 189329 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 010189329NY01 | 01 | NY | ANTH | OTHER | NY6798 | 01 | NY | PHS | OTHER | 01524758 | 05 | NY | MEDICAID | 2999503 | 01 | NY | CIGNA | OTHER | 040426011772 | 01 | NY | BHP | OTHER | 4494737 | 01 | NY | AETNA | OTHER | 0006424 | 01 | NY | GHI | OTHER | 319915 | 01 | NY | MVP | OTHER | 13319642703 | 01 | NY | 1199 | OTHER | 41687 | 01 | NY | GHI HMO | OTHER | 189329 | 01 | NY | HIP | OTHER |