Provider Demographics
NPI:1477509016
Name:GARY K RACHLIN DO PLLC
Entity Type:Organization
Organization Name:GARY K RACHLIN DO PLLC
Other - Org Name:ADVANCED FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-731-1900
Mailing Address - Street 1:4230 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5700
Mailing Address - Country:US
Mailing Address - Phone:516-731-1900
Mailing Address - Fax:516-731-7302
Practice Address - Street 1:4230 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5700
Practice Address - Country:US
Practice Address - Phone:516-731-1900
Practice Address - Fax:516-731-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER
NYG96256Medicare UPIN
NYWEW151Medicare PIN
NYLC052S8110Medicare PIN
NYGR045H7110Medicare PIN