Provider Demographics
NPI:1639361355
Name:REHANA LATIF PHYSICIAN P.C.
Entity Type:Organization
Organization Name:REHANA LATIF PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-337-3253
Mailing Address - Street 1:130 PONDFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4016
Mailing Address - Country:US
Mailing Address - Phone:914-337-3253
Mailing Address - Fax:914-771-5278
Practice Address - Street 1:130 PONDFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4016
Practice Address - Country:US
Practice Address - Phone:914-337-3253
Practice Address - Fax:914-337-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011943103TC0700X
NY054935-11041C0700X
NY1873752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEF691Medicare PIN