Provider Demographics
NPI:1487648176
Name:RABITO, PHILIP (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:RABITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E 75TH ST
Mailing Address - Street 2:11DEF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2854
Mailing Address - Country:US
Mailing Address - Phone:877-703-3775
Mailing Address - Fax:866-237-6449
Practice Address - Street 1:150 E 77TH ST OFC 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1922
Practice Address - Country:US
Practice Address - Phone:877-703-3775
Practice Address - Fax:866-237-6449
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02091725Medicaid
NY5388URMedicare PIN
NY02091725Medicaid
NYH13525Medicare UPIN
NYA13525Medicare UPIN
NY5393SDMedicare PIN