Provider Demographics
NPI:1790865764
Name:ELKOUSTAF, RACHID (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHID
Middle Name:
Last Name:ELKOUSTAF
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 1:4 ATRIUM DR
Mailing Address - Street 2:STE 100, ATTN: TAMMY M. TAFT
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1522
Mailing Address - Country:US
Mailing Address - Phone:518-435-2740
Mailing Address - Fax:518-458-2610
Practice Address - Street 1:111 MARYS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5852
Practice Address - Country:US
Practice Address - Phone:845-339-3663
Practice Address - Fax:845-339-3629
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244744207UN0901X
MN102692207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4RR92NW001OtherMEDICARE - DOWNSTATE
NY02890857Medicaid
NYRB5458OtherMEDICARE - UPSTATE
NYI63256Medicare UPIN