Provider Demographics
NPI:1194237412
Name:RACHAEL TIMBERLAKE
Entity type:Organization
Organization Name:RACHAEL TIMBERLAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMBERLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-214-7123
Mailing Address - Street 1:221 E 18TH ST APT 6J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4732
Mailing Address - Country:US
Mailing Address - Phone:917-214-7123
Mailing Address - Fax:
Practice Address - Street 1:20 W 20TH ST STE 1002
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9252
Practice Address - Country:US
Practice Address - Phone:917-214-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002549261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty