Healthcare Provider Details

I. General information

NPI: 1750466108
Provider Name (Legal Business Name): ANDREW D. RACINE MD,PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 EASTCHESTER RD SUITE 102
BRONX NY
10461-2604
US

IV. Provider business mailing address

1621 EASTCHESTER RD SUITE 102
BRONX NY
10461-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8040
  • Fax: 718-405-8048
Mailing address:
  • Phone: 718-405-8040
  • Fax: 718-405-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: