=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003781915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPPORE MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 STAMFORD PLZ FL 9
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06901-3271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-564-0480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 442 5TH AVE # 1983
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10018-2794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-564-0480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRIAN KINSELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-564-0480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------