Healthcare Provider Details

I. General information

NPI: 1770164212
Provider Name (Legal Business Name): RACHEL MANCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 STONY BROOK RD BLDG F
STONY BROOK NY
11790-2206
US

IV. Provider business mailing address

1320 STONY BROOK RD STE 200
STONY BROOK NY
11790-2215
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4200
  • Fax:
Mailing address:
  • Phone: 631-444-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number344071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: