Individual
DR. RAPHY R REBANAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
624 MCCLELLAN ST, SUITE 202, SCHENECTADY, NY 12304-1088
(518) 377-6429
(518) 377-1291
Mailing address
624 MCCLELLAN ST, SUITE 202, SCHENECTADY, NY 12304-1088
(518) 377-6429
(518) 377-1291
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
134189
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00551799
—
NY
01
—
02113
MUP
—
01
—
040426006708
FIDELIS
—
01
—
1000052185
AFFINITY
—
01
—
10001688
CDPHP
—
01
—
74E73
BC
—
Enumeration date
09/12/2006
Last updated
07/08/2007
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