MEDICARE: RACHEL BETH WELLNER MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	235175	NY

General Provider Information

NPI Number	:	1124280318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL BETH WELLNER MD, MPH

Provider Business Mailing Address
First Line	:	PO BOX 2625
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-8925
Country	:	US
Telephone Number	:	212-979-4572
Fax Number	:	212-979-4510

Provider Business Practice Location Address
First Line	:	77 WORTH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-3411
Country	:	US
Telephone Number	:	212-966-3901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	01/04/2012

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