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General NPI Number Information
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NPI Number | 1518978634
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Entity Type | Individual
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Provider Name | JEREMIE RACHUNOW M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 3974 AMBOY RD STE 302
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2414
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Country | US
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Telephone | 718-967-1071
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Fax | 718-966-0359
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Provider Business Mailing Address
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Address Line | 250 E 54TH ST APT 29B
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City | NEW YORK
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State | NY
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Zip | 10022-4816
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Country | US
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Telephone | 718-967-1071
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Fax | 718-966-0359
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 220017
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License Number State | NY
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