Healthcare Provider Details

I. General information

NPI: 1588761092
Provider Name (Legal Business Name): ALRABI N TAWIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

PO BOX 278984
ROCHESTER NY
14627-8984
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-6372
  • Fax: 585-273-1255
Mailing address:
  • Phone: 585-275-6372
  • Fax: 585-273-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number196443
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number196443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: