Healthcare Provider Details

I. General information

NPI: 1609459007
Provider Name (Legal Business Name): JEFFREY RUSSELL ARACE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 AUDUBON AVE
NEW YORK NY
10032-2248
US

IV. Provider business mailing address

622 W 168TH ST PH 4-124
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3273
  • Fax: 212-305-6692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number344292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: