Provider Demographics
NPI:1528837457
Name:GREENBAUM, RACHEL ALLIE (PA: NCCPA ID 1208210)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALLIE
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:PA: NCCPA ID 1208210
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Mailing Address - Street 1:16221 POWELLS COVE BLVD APT 5R
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1451
Mailing Address - Country:US
Mailing Address - Phone:718-517-0662
Mailing Address - Fax:
Practice Address - Street 1:16221 POWELLS COVE BLVD APT 5R
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1451
Practice Address - Country:US
Practice Address - Phone:718-517-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant