Healthcare Provider Details

I. General information

NPI: 1861656837
Provider Name (Legal Business Name): RACHAEL GREEN BILELLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 N BROADWAY
JERICHO NY
11753
US

IV. Provider business mailing address

380 N BROADWAY STE L2
JERICHO NY
11753-2109
US

V. Phone/Fax

Practice location:
  • Phone: 866-621-2769
  • Fax:
Mailing address:
  • Phone: 516-931-1776
  • Fax: 516-942-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: