Healthcare Provider Details

I. General information

NPI: 1205612330
Provider Name (Legal Business Name): GABRIELA RACHMACIEJ AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HACKENSACK AVE STE 204
HACKENSACK NJ
07601-6454
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL ENTA4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 201-883-1062
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003213
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00127700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: