Provider Demographics
NPI:1205259082
Name:NORBERT W. RAINFORD MD, PLLC
Entity type:Organization
Organization Name:NORBERT W. RAINFORD MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:RAINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-639-8240
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-639-8240
Mailing Address - Fax:845-639-8259
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-639-8240
Practice Address - Fax:845-639-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122512261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty