Provider Demographics
NPI:1437390952
Name:CHILDRENS MEDICAL PRACTICE OF BRONXVILLE
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL PRACTICE OF BRONXVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:RABUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-7474
Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3925
Mailing Address - Country:US
Mailing Address - Phone:914-337-7474
Mailing Address - Fax:914-961-0058
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3925
Practice Address - Country:US
Practice Address - Phone:914-337-7474
Practice Address - Fax:914-961-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty