Provider Demographics
NPI:1861627945
Name:RATHE, PAUL G (LAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:RATHE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 N MAIN ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4229
Mailing Address - Country:US
Mailing Address - Phone:914-939-0003
Mailing Address - Fax:914-939-0507
Practice Address - Street 1:125 N MAIN ST
Practice Address - Street 2:SUITE 502
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4229
Practice Address - Country:US
Practice Address - Phone:914-939-0003
Practice Address - Fax:914-939-0507
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist