Healthcare Provider Details

I. General information

NPI: 1356532758
Provider Name (Legal Business Name): RAHKIL MAIZEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4568A SUNRISE HWY
OAKDALE NY
11769
US

IV. Provider business mailing address

82 MIDDLE COUNTRY RD
CORAM NY
11727-4411
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-8542
  • Fax:
Mailing address:
  • Phone: 631-320-2220
  • Fax: 631-698-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number245449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: