Provider Demographics
NPI:1487970786
Name:HERBST, RAYMOND (RN)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:HERBST
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:RAYMOND
Other - Middle Name:
Other - Last Name:HERBST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:665 STONELEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4625
Mailing Address - Country:US
Mailing Address - Phone:845-279-5711
Mailing Address - Fax:
Practice Address - Street 1:665 STONELEIGH AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4625
Practice Address - Country:US
Practice Address - Phone:845-279-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606697163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health