Provider Demographics
NPI:1972525954
Name:EYASSU, RAHEL (MD)
Entity Type:Individual
Prefix:
First Name:RAHEL
Middle Name:
Last Name:EYASSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 2ND AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7406
Mailing Address - Country:US
Mailing Address - Phone:212-360-7893
Mailing Address - Fax:212-360-7400
Practice Address - Street 1:1900 2ND AVE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7406
Practice Address - Country:US
Practice Address - Phone:212-360-7893
Practice Address - Fax:212-360-7400
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216680207R00000X
NJMA066430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG94041Medicare UPIN
NY853571Medicare ID - Type Unspecified