Healthcare Provider Details

I. General information

NPI: 1679032437
Provider Name (Legal Business Name): ERICA LARA RABINOVICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE M100
NEW HYDE PARK NY
11042-2062
US

IV. Provider business mailing address

4200 WISCONSIN AVE NW STE 4
WASHINGTON DC
20016-2143
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3650
  • Fax:
Mailing address:
  • Phone: 202-243-3400
  • Fax: 202-243-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number317424-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: