Basic Information
| Provider Information | |||||||||
| NPI: | 1356615702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LYDIA RABINOWICH MD PC | ||||||||
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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: | 03/02/2012 | ||||||||
| LastUpdateDate: | 03/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | RABINOWICH | ||||||||
| AuthorizedOfficialFirstName: | LYDIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7184094044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 01111095 | 05 | NY | MEDICAID |