MEDICARE: JEREMIE RACHUNOW M.D.

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	207Q00000X	Family Medicine Physician	220017	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JR05372D10	OTHER	NY	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518978634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIE RACHUNOW M.D.

Provider Business Mailing Address
First Line	:	250 E 54TH ST APT 29B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4816
Country	:	US
Telephone Number	:	718-967-1071
Fax Number	:	718-966-0359

Provider Business Practice Location Address
First Line	:	3974 AMBOY RD STE 302
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2414
Country	:	US
Telephone Number	:	718-967-1071
Fax Number	:	718-966-0359

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	01/19/2026

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Directions to “ JEREMIE RACHUNOW M.D.” Practice Location

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