Provider Demographics
NPI:1942227509
Name:RAINCE, GURMUKH S (MD)
Entity Type:Individual
Prefix:DR
First Name:GURMUKH
Middle Name:S
Last Name:RAINCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GURMUKH
Other - Middle Name:S
Other - Last Name:RAINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11407 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1138
Mailing Address - Country:US
Mailing Address - Phone:718-805-1358
Mailing Address - Fax:718-805-6911
Practice Address - Street 1:11407 101ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1138
Practice Address - Country:US
Practice Address - Phone:718-805-1358
Practice Address - Fax:718-805-6911
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0918305Medicaid
NY38554Medicare ID - Type Unspecified
NYB87410Medicare UPIN