Basic Information
| Provider Information | |||||||||
| NPI: | 1881828325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAXMAN | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 CLARKSON AVE | ||||||||
| Address2: | 7TH FLOOR, R BUILDING | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182452212 | ||||||||
| FaxNumber: | 7182452517 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 CLARKSON AVE | ||||||||
| Address2: | 7TH FLOOR, R BUILDING | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182452212 | ||||||||
| FaxNumber: | 7182452517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 46560 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084P0804X | 46560 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | 46560 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208000000X | 57.020591 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084P0804X | 275339 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 208000000X | 275339 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7100251410 | 05 | KY | MEDICAID |