Provider Demographics
NPI:1821572231
Name:RAUCHUT, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:RAUCHUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-0686
Mailing Address - Country:US
Mailing Address - Phone:631-325-8030
Mailing Address - Fax:
Practice Address - Street 1:7 RAFFAELLA DR
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1448
Practice Address - Country:US
Practice Address - Phone:631-325-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526090-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse