Provider Demographics
NPI:1134214448
Name:JORDAN W RACHLIN DPM PC
Entity type:Organization
Organization Name:JORDAN W RACHLIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RACHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-472-9272
Mailing Address - Street 1:221 E HARTSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3572
Mailing Address - Country:US
Mailing Address - Phone:914-472-9272
Mailing Address - Fax:914-472-9321
Practice Address - Street 1:221 E HARTSDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3572
Practice Address - Country:US
Practice Address - Phone:914-472-9272
Practice Address - Fax:914-472-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4369401OtherAETNA HEALTH PLANS
NY47808POtherHIP
NY00418075Medicaid
NY10053408OtherCDHP
NY480020684OtherMEDICAIRE RAILROAD
NY480033899OtherMEDICAIRE RAILROAD
NY0076764OtherGHI
NY220-148OtherWORKMANS COMP.
NY2C6600OtherHEALTHNET HEALTH PLAN
NYP27582OtherEMPIRE BC/BS
NYAA1073OtherEMPIRE BC/BS
NYP27581OtherEMPIRE BC/BS
NYYS094OtherOXFORD
NY220-148OtherWORKMANS COMP.
NY00418075Medicaid
NY47808POtherHIP
NY3885290001Medicare NSC