Healthcare Provider Details

I. General information

NPI: 1215104583
Provider Name (Legal Business Name): RACHID BENJELLOUN TOUIMY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD ROOM 725
BRONX NY
10461
US

IV. Provider business mailing address

1135 SECRETARIAT CT
GREAT FALLS VA
22066-1715
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4105
  • Fax: 718-904-2659
Mailing address:
  • Phone: 917-783-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number003687
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number003687
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD85295
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: