Provider Demographics
NPI:1518978634
Name:RACHUNOW, JEREMIE (MD)
Entity type:Individual
Prefix:
First Name:JEREMIE
Middle Name:
Last Name:RACHUNOW
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 1:250 E 54TH ST APT 29B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4816
Mailing Address - Country:US
Mailing Address - Phone:917-447-0840
Mailing Address - Fax:212-532-6666
Practice Address - Street 1:120 E 36TH ST STE 1E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3423
Practice Address - Country:US
Practice Address - Phone:917-447-0840
Practice Address - Fax:212-532-6666
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJR05372D10OtherBLUE CROSS BLUE SHIELD
NYJR05028A10Medicare PIN