Healthcare Provider Details

I. General information

NPI: 1821617473
Provider Name (Legal Business Name): LILY AMANDA RABINOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3411 WAYNE AVE
BRONX NY
10467-2509
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6781
  • Fax:
Mailing address:
  • Phone: 508-654-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number324835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: