MEDICARE: RACHEL PLATT BS

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	174400000X	Specialist	3636437	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3636437	OTHER	NY	NYS

General Provider Information

NPI Number	:	1760921290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL PLATT BS

Provider Business Mailing Address
First Line	:	6190 E LAKE RD
Second Line	:
City	:	BURT
State	:	NY
Zip	:	14028-9705
Country	:	US
Telephone Number	:	716-297-0798
Fax Number	:	716-297-0998

Provider Business Practice Location Address
First Line	:	6190 E LAKE RD
Second Line	:
City	:	BURT
State	:	NY
Zip	:	14028-9705
Country	:	US
Telephone Number	:	716-297-0798
Fax Number	:	716-297-0998

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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