Healthcare Provider Details

I. General information

NPI: 1245643907
Provider Name (Legal Business Name): RACHEL BOHNEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13514 JEWEL AVE
FLUSHING NY
11367-1920
US

IV. Provider business mailing address

400 CENTRAL PARK W APT 9E
NEW YORK NY
10025-5880
US

V. Phone/Fax

Practice location:
  • Phone: 718-997-6453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number058709-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: