Basic Information
| Provider Information | |||||||||
| NPI: | 1265799175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAELENE LADAGA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 NEW MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109271548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142755462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 NEW MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109271548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142755462 | ||||||||
| FaxNumber: | 8453583640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 04/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | LADAGA | ||||||||
| AuthorizedOfficialFirstName: | RAELENE | ||||||||
| AuthorizedOfficialMiddleName: | RUBILLOS | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 9142755462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 225918 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.