Basic Information
| Provider Information | |||||||||
| NPI: | 1720611312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERLAAN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD,PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 W 165TH ST APT B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100327912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4162628810 | ||||||||
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| Practice Location | |||||||||
| Address1: | NEWYORK-PRESBYTERIAN MORGAN STANLEY CHILDREN'S HOSPITAL | ||||||||
| Address2: | 3959 BROADWAY AVE SUITE: 274 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2020 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 300560 | NY | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.