Organization
NADEREH RAFAT, M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NADEREH RAFAT M.D. (PRESIDENT)
(914) 667-1620
Entity
Organization
Contact information
Practice address
153 STEVENS AVE, SUITE # 5, MOUNT VERNON, NY 10550-2597
(914) 667-1620
(914) 667-2421
Mailing address
153 STEVENS AVE, SUITE # 5, MOUNT VERNON, NY 10550-2597
(914) 667-1620
(914) 667-2421
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
145111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00768107
—
NY
01
—
145111
LICENCE #
NY
01
—
79A912
MEDICARE PTAN #
NY
Enumeration date
03/16/2012
Last updated
03/16/2012
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