Healthcare Provider Details

I. General information

NPI: 1588926190
Provider Name (Legal Business Name): RACHEL KOBZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 06/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 NEW LOUDON RD
LATHAM NY
12110-4031
US

IV. Provider business mailing address

1145 ROUTE 208
WALLKILL NY
12589-3714
US

V. Phone/Fax

Practice location:
  • Phone: 518-782-1178
  • Fax:
Mailing address:
  • Phone: 845-863-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number426136101
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number426135101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: