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General NPI Number Information
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NPI Number | 1215243449
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Entity Type | Organization
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Legal Business Name | RAINBOW MEDICAL HOME PEDIATRICS, LLC
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 4415 BUFFALO RD
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City | NORTH CHILI
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State | NY
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Zip | 14514-1024
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Country | US
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Telephone | 585-594-5008
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Fax | 585-594-1003
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Provider Business Mailing Address
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Address Line | 4415 BUFFALO RD
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City | NORTH CHILI
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State | NY
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Zip | 14514-1024
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Country | US
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Telephone | 585-594-5008
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Fax | 585-594-1003
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Authorized Official
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Title or Position | OWNER
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Name | DR. PIUSH SHARMA
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Credential | MD
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Telephone | 585-594-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 140437
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License Number State | NY
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