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General NPI Number Information
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NPI Number | 1437390952
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Entity Type | Organization
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Legal Business Name | CHILDRENS MEDICAL PRACTICE OF BRONXVILLE
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 1 ELM ST SUITE 1B
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City | TUCKAHOE
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State | NY
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Zip | 10707-3925
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Country | US
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Telephone | 914-337-7474
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Fax | 914-961-0058
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Provider Business Mailing Address
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Address Line | 1 ELM ST SUITE 1B
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City | TUCKAHOE
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State | NY
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Zip | 10707-3925
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Country | US
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Telephone | 914-337-7474
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Fax | 914-961-0058
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC J RABUSE
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Credential | MD
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Telephone | 914-337-7474
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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 | 121063
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License Number State | NY
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