Individual provider Active NPI

Miriam Tzipora Rackoff, WHNP

  • Women's Health Nurse Practitioner
  • New Square, NY
National Provider Identifier
1366944423
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
421323 Issued in NY
Practice address
728 N Main St
New Square, NY 10977-8916
Phone
(845) 354-9300
NPI assigned
Mar 5, 2018
Last updated
Oct 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 421323 NY Primary

Addresses

Primary practice location

728 N Main St
New Square, NY 10977-8916

Mailing address

7 Scotford St
Spring Valley, NY 10977-1423
Phone (773) 877-0582

Other practice location 1

1305 York Ave Fl 6
New York, NY 10021-5663
Phone (646) 962-2764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191113002723 NY Practitioner - Nurse Practitioner 8022440064 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
421323NYMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Refuah Health Center Inc CurrentSince Oct 28, 2019 Accepting new patients
Refuah Health Center, Inc. CurrentSince Oct 28, 2019 Accepting new patients
Refuah Health Center, Inc. Past Accepting new patients

Locations

728 N Main St
New Square, NY 10977
Phone (845) 354-9301

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1366944423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SCOTFORD ST",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109771423",
            "telephone_number": "773-877-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 N MAIN ST",
            "city": "NEW SQUARE",
            "state": "NY",
            "postal_code": "109778916",
            "telephone_number": "845-354-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1305 York Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100215663",
            "country_code": "US",
            "telephone_number": "646-962-2764",
            "fax_number": "646-962-0329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACKOFF",
        "first_name": "MIRIAM",
        "middle_name": "TZIPORA",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-05",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "421323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Square, NY

Sources for this page

Verify at the official NPI Registry.