Basic Information
| Provider Information | |||||||||
| NPI: | 1790865764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELKOUSTAF | ||||||||
| FirstName: | RACHID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ATRIUM DR | ||||||||
| Address2: | STE 100, ATTN: TAMMY M. TAFT | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184352740 | ||||||||
| FaxNumber: | 5184582610 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MARYS AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124015852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453393663 | ||||||||
| FaxNumber: | 8453393629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 244744 | NY | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 102692 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 4RR92NW001 | 01 | NY | MEDICARE - DOWNSTATE | OTHER | 02890857 | 05 | NY | MEDICAID | RB5458 | 01 | NY | MEDICARE - UPSTATE | OTHER |