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General NPI Number Information
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NPI Number | 1053510131
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Entity Type | Organization
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Legal Business Name | GOLDROCK MEDICAL, P.C.
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 139 FULTON ST # 703
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City | NEW YORK
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State | NY
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Zip | 10038-2594
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Country | US
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Telephone | 212-406-0128
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Fax |
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Provider Business Mailing Address
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Address Line | 139 FULTON ST # 703
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City | NEW YORK
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State | NY
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Zip | 10038-2594
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Country | US
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Telephone | 212-406-0128
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JEREMIE RACHUNOW
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Credential | MD
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Telephone | 973-575-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 220017
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License Number State | NY
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