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General NPI Number Information
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NPI Number | 1013452754
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Entity Type | Organization
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Legal Business Name | RAHAV WELLNESS LLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 205 W 15TH ST SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10011-6412
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Country | US
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Telephone | 646-789-3952
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W 15TH ST SUITE 1B
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City | NEW YORK
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State | NY
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Zip | 10011-6412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND MEDICAL DIRECTOR
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Name | DR. MIRIAM RAHAV
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Credential | M.D.
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Telephone | 646-789-3952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 264399
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License Number State | NY
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