Healthcare Provider Details

I. General information

NPI: 1720226319
Provider Name (Legal Business Name): NELLY RACHEL RABINOWITZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN AVE BRIGGS HIGH SCHOOL
NORWALK CT
06851-1510
US

IV. Provider business mailing address

172 CARRINGTON RD
BETHANY CT
06524-3509
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-6385
  • Fax: 203-846-6395
Mailing address:
  • Phone: 203-393-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number000017
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: