Provider Demographics
NPI:1134616642
Name:JOHENGEN, RACHAEL BETH (DO)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:BETH
Last Name:JOHENGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:BETH
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 ELLEN POLIMENI BLVD APT 223
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2251
Mailing Address - Country:US
Mailing Address - Phone:585-813-2023
Mailing Address - Fax:
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1694
Practice Address - Country:US
Practice Address - Phone:315-787-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty