Healthcare Provider Details

I. General information

NPI: 1578524138
Provider Name (Legal Business Name): MINDY STIMELL-RAUCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/27/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNVERSITY DEPARTMENT PEDIATRIC
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 221-304-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 212-304-7297
  • Fax: 212-544-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number192683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: