MEDICARE: RAHIM DITTA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1861225625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHIM DITTA

Provider Business Mailing Address
First Line	:	1 W LAWRENCE PARK DR UNIT 12
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-3104
Country	:	US
Telephone Number	:	845-587-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W LAWRENCE PARK DR UNIT 12
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-3104
Country	:	US
Telephone Number	:	845-587-8391
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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Directions to “ RAHIM DITTA ” Practice Location

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