Individual
ALLAN WAYDE RASBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9715 64TH RD, REGO PARK, NY 11374-2250
(718) 459-5592
(718) 459-6047
Mailing address
180 LENOX RD, APT.4N, BROOKLYN, NY 11226-2486
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
282388
NY
Other
Enumeration date
11/02/2009
Last updated
11/02/2009
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