Provider Demographics
NPI:1578721452
Name:MENAGED, RACHEL ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELISE
Last Name:MENAGED
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 1:451 E 83RD ST
Mailing Address - Street 2:APT. 11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6123
Mailing Address - Country:US
Mailing Address - Phone:917-626-8956
Mailing Address - Fax:
Practice Address - Street 1:1111 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1234
Practice Address - Country:US
Practice Address - Phone:212-534-3000
Practice Address - Fax:212-996-8420
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics