Healthcare Provider Details

I. General information

NPI: 1265081525
Provider Name (Legal Business Name): REBEKA RACZ WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CLINTON AVE
BROOKLYN NY
11238-6589
US

IV. Provider business mailing address

535 CLINTON AVE
BROOKLYN NY
11238-6589
US

V. Phone/Fax

Practice location:
  • Phone: 917-410-6905
  • Fax: 646-878-6095
Mailing address:
  • Phone: 917-410-6905
  • Fax: 646-878-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: