Provider Demographics
NPI:1538198940
Name:LANDRES, RACHEL (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LANDRES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:914-493-8558
Mailing Address - Fax:914-493-1488
Practice Address - Street 1:22 SAW MILL RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1533
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007702363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02575120Medicaid