Provider Demographics
NPI:1982765210
Name:RAKOWITZ, FREDERIC (MD PHD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:RAKOWITZ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1720
Mailing Address - Country:US
Mailing Address - Phone:516-482-7351
Mailing Address - Fax:516-482-7351
Practice Address - Street 1:76 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1720
Practice Address - Country:US
Practice Address - Phone:516-482-7351
Practice Address - Fax:516-482-7351
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
62A691Medicare UPIN
NYB17149Medicare UPIN
B17149Medicare UPIN