Provider Demographics
NPI:1467765685
Name:FREDERIC RAKOWITZ, M.D., PH.D., PC
Entity Type:Organization
Organization Name:FREDERIC RAKOWITZ, M.D., PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:516-482-4940
Mailing Address - Street 1:295 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-4940
Mailing Address - Fax:516-482-4913
Practice Address - Street 1:295 NORTHERN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4701
Practice Address - Country:US
Practice Address - Phone:516-482-4940
Practice Address - Fax:516-482-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62A691Medicare UPIN