Provider Demographics
NPI:1982826780
Name:RATH, CAROLINE JEAN (PA)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:JEAN
Last Name:RATH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:RATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:227 MADISON ST
Mailing Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7680
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004640363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004640OtherPHYSICIAN ASSISTANT LICENSE
AZ4278OtherARIZONA STATE PHYSICIAN ASSISTANT LICENSE
S80343Medicare UPIN