Provider Demographics
NPI:1790949253
Name:RAUCH, STUART J (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:RAUCH
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 1:515 W END AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4345
Mailing Address - Country:US
Mailing Address - Phone:212-595-0242
Mailing Address - Fax:
Practice Address - Street 1:515 W END AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4345
Practice Address - Country:US
Practice Address - Phone:212-595-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1326922084P0800X
NJ25MA040767002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08058Medicare UPIN