Healthcare Provider Details

I. General information

NPI: 1043272081
Provider Name (Legal Business Name): SIDNEY RABINOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/31/2011
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 Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMA60069
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:
Title or Position:
Credential:
Phone: