Individual
DR. RACHID ELKOUSTAF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 MARYS AVE, SUITE 3, KINGSTON, NY 12401-5852
(845) 339-3663
(845) 339-3629
Mailing address
4 ATRIUM DR, STE 100, ATTN: TAMMY M. TAFT, ALBANY, NY 12205-1522
(518) 435-2740
(518) 458-2610
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
102692
MN
207UN0901X
Nuclear Cardiology Physician
244744
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02890857
—
NY
01
—
4RR92NW001
MEDICARE - DOWNSTATE
NY
01
—
RB5458
MEDICARE - UPSTATE
NY
Enumeration date
10/16/2006
Last updated
12/08/2021
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