Provider Demographics
NPI:1215243449
Name:RAINBOW MEDICAL HOME PEDIATRICS, LLC
Entity type:Organization
Organization Name:RAINBOW MEDICAL HOME PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PIUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-594-5008
Mailing Address - Street 1:4415 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1024
Mailing Address - Country:US
Mailing Address - Phone:585-594-5008
Mailing Address - Fax:585-594-1003
Practice Address - Street 1:4415 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1024
Practice Address - Country:US
Practice Address - Phone:585-594-5008
Practice Address - Fax:585-594-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00456982Medicaid