Healthcare Provider Details

I. General information

NPI: 1104988641
Provider Name (Legal Business Name): RACHEL J KUTTICHIRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N GRAND AVE RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
BALDWIN NY
11510
US

IV. Provider business mailing address

1908 N GRAND AVE RACHEL J KUTTICHIRA MD PC BALDWIN PEDIATRIC CARE
BALDWIN NY
11510
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-4120
  • Fax: 516-377-7746
Mailing address:
  • Phone: 516-377-4120
  • Fax: 516-377-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number140888
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier004710
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
IdentifierAP248
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD
# 3
Identifier125139
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: