Provider Demographics
NPI:1285642694
Name:RAKHMAN, JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:RAKHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:RAKHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:81 IRVING PLACE
Mailing Address - Street 2:STE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-228-6777
Mailing Address - Fax:212-280-9529
Practice Address - Street 1:81 IRVING PLACE
Practice Address - Street 2:STE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-228-6777
Practice Address - Fax:212-280-9529
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147445208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00899041Medicaid
45D801Medicare ID - Type Unspecified
B14897Medicare UPIN