=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174804066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STUART RASCH, M.D., P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2011
-----------------------------------------------------
Last Update Date | 09/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 ROUTE 59
-----------------------------------------------------
City | AIRMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10952-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-357-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 SICKLETOWN RD
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-735-6603
-----------------------------------------------------
Fax | 845-201-8190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STUART RASCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-735-6603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | 185778
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------