Healthcare Provider Details

I. General information

NPI: 1396075404
Provider Name (Legal Business Name): SIDNEY RABINOWITZ, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 PROSPECT AVE
HACKENSACK NJ
07601-2570
US

IV. Provider business mailing address

385 PROSPECT AVE
HACKENSACK NJ
07601-2570
US

V. Phone/Fax

Practice location:
  • Phone: 201-525-0220
  • Fax: 201-525-0015
Mailing address:
  • Phone: 201-525-0220
  • Fax: 201-525-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA06006900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6289703
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. SIDNEY RABINOWITZ
Title or Position: OWNER
Credential: MD
Phone: 201-525-0220