Basic Information
Provider Information | |||||||||
NPI: | 1962718833 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RHYMAUN | ||||||||
FirstName: | RACHEL | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHYSICIAN ASSISTANT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEEKS | ||||||||
OtherFirstName: | RACHEL | ||||||||
OtherMiddleName: | E | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHYSICIAN ASSISTANT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2000 | ||||||||
Address2: |   | ||||||||
City: | HUDSON | ||||||||
State: | NY | ||||||||
PostalCode: | 125342000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5188288363 | ||||||||
FaxNumber: | 5186973388 | ||||||||
Practice Location | |||||||||
Address1: | 23 FISH AND GAME RD | ||||||||
Address2: |   | ||||||||
City: | HUDSON | ||||||||
State: | NY | ||||||||
PostalCode: | 125343815 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5188287644 | ||||||||
FaxNumber: | 5188281236 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2010 | ||||||||
LastUpdateDate: | 08/30/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 014137 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | W79533 | 01 | NY | MEDICARE GROUP | OTHER |