Healthcare Provider Details

I. General information

NPI: 1144667510
Provider Name (Legal Business Name): RACHAEL HEYDEN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2013
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE 16F
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

1090 AMSTERDAM AVE 16F
NEW YORK NY
10025-1737
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-5089
  • Fax:
Mailing address:
  • Phone: 212-523-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number288421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: