Healthcare Provider Details

I. General information

NPI: 1093752263
Provider Name (Legal Business Name): JOHN C RAUSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/18/2019
Certification Date:
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 COLUMBIA UNVERSITY DEPARTMENT PEDIATRIC
NEW YORK NY
10032-1559
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number232241
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: