Healthcare Provider Details

I. General information

NPI: 1578876132
Provider Name (Legal Business Name): YONIT STERBA RAKOVCHIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-2456
  • Fax: 718-944-0463
Mailing address:
  • Phone: 786-624-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberME132187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: