Provider Demographics
NPI:1467447862
Name:RATHAN, ALLISON PORTIA (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PORTIA
Last Name:RATHAN
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 1:1250 57TH STREET
Mailing Address - Street 2:MAIMONIDES ADULT PRIMARY CARE CLINIC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-283-5700
Mailing Address - Fax:
Practice Address - Street 1:1250 57TH ST
Practice Address - Street 2:MAIMONIDES ADULT PRIMARY CARE CLINIC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4537
Practice Address - Country:US
Practice Address - Phone:718-283-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192459207R00000X
NJ25MA07850800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35484Medicare UPIN
NY427991Medicare PIN