Healthcare Provider Details

I. General information

NPI: 1144314360
Provider Name (Legal Business Name): SIMON S RABINOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LENOX RD DEPT OF PEDIATRICS, BOX 49
BROOKLYN NY
11203-2098
US

IV. Provider business mailing address

445 LENOX RD DEPT OF PEDIATRICS, BOX 49
BROOKLYN NY
11203-2098
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1647
  • Fax: 718-270-1985
Mailing address:
  • Phone: 718-270-1647
  • Fax: 718-270-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number161072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: