Individual
MISS RAPHAELA GASSANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
110 W 14TH ST, NEW YORK, NY 10011-7303
(212) 481-3333
Mailing address
1355 E 18TH ST APT 6C, BROOKLYN, NY 11230-7567
(732) 239-9288
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
029741
NY
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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