Provider Demographics
NPI:1508845850
Name:RAUSCHENBACH, KENNETH K (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:RAUSCHENBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6027
Mailing Address - Country:US
Mailing Address - Phone:845-454-0120
Mailing Address - Fax:845-454-6080
Practice Address - Street 1:1910 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6027
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:845-454-6080
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213245207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01933760Medicaid
NY110355800OtherU.S. DEPT. OF LABOR
NY7418989-001OtherCIGNA
NY2156641OtherAETNA
NY5320OtherSIEBA
NY10033385OtherCDPHP
NYP1278929OtherOXFORD FREEDOM PLAN
NY83G831OtherEMPIRE BC/BS
NY187700OtherMVP HEALTHCARE
NY100016273OtherAFFINITY HEALTHPLAN
NYOR-0000332OtherSELECT PROVIDERS
NY200036796OtherRAIL ROAD MEDICARE
NY01933760Medicaid
NY10033385OtherCDPHP