Individual
IRENE RAPHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
66 COMMACK RD STE 20018, COMMACK, NY 11725-3405
(631) 858-2190
Mailing address
18 BETHAL LN, COMMACK, NY 11725-1004
(631) 827-9841
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308880
NY
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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