=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972026052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL COLANTUONO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2017
-----------------------------------------------------
Last Update Date | 07/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 WESTCHESTER AVE STE 300
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-420-4881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 S ECKAR ST
-----------------------------------------------------
City | IRVINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10533-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------