Provider Demographics
NPI:1417218280
Name:TRACHTMAN, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TRACHTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 246TH ST
Mailing Address - Street 2:APT 1501
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 W 246TH ST
Practice Address - Street 2:APT 1501
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3611
Practice Address - Country:US
Practice Address - Phone:347-453-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDO NOT HAVE208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics