Provider Demographics
NPI:1649209727
Name:ROCKWELL MEDICAL PC
Entity type:Organization
Organization Name:ROCKWELL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEREMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHUNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-447-0840
Mailing Address - Street 1:120 E 36TH ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3423
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRO0S32G610OtherBLUE CROSS BLUE SHIELD
NYRO0S32G610OtherBLUE CROSS BLUE SHIELD