Provider Demographics
NPI:1649209727
Name:ROCKWELL MEDICAL PC
Entity Type:Organization
Organization Name:ROCKWELL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEREMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHUNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-406-0134
Mailing Address - Street 1:271 ROUTE 46 W STE G208
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2475
Mailing Address - Country:US
Mailing Address - Phone:973-575-7626
Mailing Address - Fax:
Practice Address - Street 1:33 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3811
Practice Address - Country:US
Practice Address - Phone:914-948-5156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRO0S32G610OtherBLUE CROSS BLUE SHIELD
NYRO0S32G610OtherBLUE CROSS BLUE SHIELD