Provider Demographics
NPI:1619094802
Name:RATHORE, VARINDER S (MD)
Entity Type:Individual
Prefix:
First Name:VARINDER
Middle Name:S
Last Name:RATHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WATERS PL
Mailing Address - Street 2:BLDG 102, WARD 20, FLOOR 6
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR STE 205
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2266
Practice Address - Country:US
Practice Address - Phone:845-231-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2345432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245643Medicaid
NY03017998Medicaid