Provider Demographics
NPI:1518978634
Name:RACHUNOW, JEREMIE (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIE
Middle Name:
Last Name:RACHUNOW
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 1:20 E 46TH ST RM 1102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9247
Mailing Address - Country:US
Mailing Address - Phone:212-682-5158
Mailing Address - Fax:212-682-7048
Practice Address - Street 1:139 FULTON ST RM 700
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2533
Practice Address - Country:US
Practice Address - Phone:212-406-0134
Practice Address - Fax:212-608-1325
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJR05372D10OtherBLUE CROSS BLUE SHIELD
NYJR05028A10Medicare PIN