Healthcare Provider Details

I. General information

NPI: 1689994733
Provider Name (Legal Business Name): CLAIRE LOUISE JACKSON-RABINOWITZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVENUE AT 16TH STREET MILTON AND CARROLL PETRIE DIVISION
NEW YORK NY
10003
US

IV. Provider business mailing address

10 NATHAN D PERLMAN PL FL 2
NEW YORK NY
10003-3851
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2400
  • Fax:
Mailing address:
  • Phone: 215-738-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number272674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: