Provider Demographics
NPI:1659564383
Name:RACHEL M. BAUTISTA, M.D. P.C.
Entity Type:Organization
Organization Name:RACHEL M. BAUTISTA, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-360-3442
Mailing Address - Street 1:227 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2709
Mailing Address - Country:US
Mailing Address - Phone:631-360-0877
Mailing Address - Fax:631-360-3317
Practice Address - Street 1:227 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2709
Practice Address - Country:US
Practice Address - Phone:631-360-0877
Practice Address - Fax:631-360-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152584207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZWVV1Medicare UPIN