Provider Demographics
NPI:1992787519
Name:STEIN, RACHAEL (PA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BEACH 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4812
Mailing Address - Country:US
Mailing Address - Phone:718-874-1380
Mailing Address - Fax:
Practice Address - Street 1:657 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2320
Practice Address - Country:US
Practice Address - Phone:576-374-0670
Practice Address - Fax:576-295-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant