Provider Demographics
NPI:1184638140
Name:LATIF, REHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:REHANA
Middle Name:
Last Name:LATIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PONDFIELD RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4002
Mailing Address - Country:US
Mailing Address - Phone:914-337-3253
Mailing Address - Fax:914-771-5278
Practice Address - Street 1:130 PONDFIELD RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4002
Practice Address - Country:US
Practice Address - Phone:914-337-3253
Practice Address - Fax:914-771-5278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1873752084P0804X, 2084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01472100Medicaid
NY61I381Medicare ID - Type UnspecifiedIND MEDICARE NUMBER
NY01472100Medicaid
NYWEF691Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER