| Organization Name: | MEDROCK MEDICAL PC |
| NPI Number: | 1336421411 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERENIE RACHUNOW (OWNER) |
| Mailing Address: | 139 Fulton St New York |
| State: | NY US |
| Postal Code: | 100382594 |
| Phone Number: | 2125107020 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2011 |
| NPI Last Update Date: | 09/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |