Provider Demographics
NPI:1972762953
Name:RAFAEL SOLTREN, MD, PC
Entity type:Organization
Organization Name:RAFAEL SOLTREN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERMISTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-941-1277
Mailing Address - Street 1:100 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5634
Mailing Address - Country:US
Mailing Address - Phone:914-941-1277
Mailing Address - Fax:914-941-4669
Practice Address - Street 1:100 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5634
Practice Address - Country:US
Practice Address - Phone:914-941-1277
Practice Address - Fax:914-941-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB10751Medicare UPIN
NY19D991Medicare PIN