Individual
DR. RAFAEL YAKUTILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 BEACH 105TH ST, ROCKAWAY PARK, NY 11694-2640
(718) 474-0023
(718) 474-2033
Mailing address
15 BEACH 105TH ST, ROCKAWAY PARK, NY 11694-2640
(718) 474-0023
(718) 474-2033
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
229375
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02574349
—
NY
Enumeration date
06/17/2005
Last updated
01/30/2009
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