Basic Information
| Provider Information | |||||||||
| NPI: | 1306041223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | RASHANNA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WADE-LYNCH | ||||||||
| OtherFirstName: | RASHANNA | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 W 97TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127491820 | ||||||||
| FaxNumber: | 2129328323 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W 97TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127491820 | ||||||||
| FaxNumber: | 2128660949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA08716200 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 265381-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.