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General NPI Number Information
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NPI Number | 1295044063
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Entity Type | Individual
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Provider Name | RAHIM NIZAR RAHEMTULLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 220 5TH AVE SUITE 300, OFFICE #7
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City | NEW YORK
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State | NY
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Zip | 10001-7708
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Country | US
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Telephone | 646-770-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 220 5TH AVE 11TH FLOOR/OFFICE #6
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City | NEW YORK
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State | NY
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Zip | 10001-8017
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Country | US
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Telephone | 646-770-3243
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Fax | 877-991-8148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 246132
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 246132
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 246132
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License Number State | NY
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