=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306308994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA WACHTER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2019
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2365 BOSTON POST RD STE 203
-----------------------------------------------------
City | LARCHMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10538-3559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-235-3800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 291 S HEALY AVE
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 316386
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------