Provider Demographics
NPI:1295044063
Name:RAHEMTULLA, RAHIM NIZAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHIM
Middle Name:NIZAR
Last Name:RAHEMTULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE
Mailing Address - Street 2:11TH FLOOR/OFFICE #6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-8017
Mailing Address - Country:US
Mailing Address - Phone:646-770-3243
Mailing Address - Fax:877-991-8148
Practice Address - Street 1:220 5TH AVE
Practice Address - Street 2:SUITE 300, OFFICE #7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7708
Practice Address - Country:US
Practice Address - Phone:646-770-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246132208000000X, 2084P0800X, 2084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry