Provider Demographics
NPI:1356625305
Name:RAICH, YANIV (DPT)
Entity type:Individual
Prefix:
First Name:YANIV
Middle Name:
Last Name:RAICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1702
Mailing Address - Country:US
Mailing Address - Phone:516-747-2323
Mailing Address - Fax:516-747-2305
Practice Address - Street 1:193 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-747-2323
Practice Address - Fax:516-747-2305
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031561-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist