Provider Demographics
NPI:1154581692
Name:BRILLIANT, RACHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:BRILLIANT
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:101 JORDAN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8343
Practice Address - Country:US
Practice Address - Phone:518-274-9126
Practice Address - Fax:518-274-9487
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2014-11-11
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Provider Licenses
StateLicense IDTaxonomies
NY251316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03261350Medicaid
NYJ400028032Medicare UPIN