Basic Information
| Provider Information | |||||||||
| NPI: | 1003803305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RABINOWICH | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 WATERS PL | ||||||||
| Address2: | SUITE 1203 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184094044 | ||||||||
| FaxNumber: | 7187926515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 WATERS PL | ||||||||
| Address2: | SUITE 1203 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184094044 | ||||||||
| FaxNumber: | 7187926515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2005 | ||||||||
| LastUpdateDate: | 03/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 140499 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 01111095 | 05 | NY | MEDICAID |