Individual
MIRA RAFAILOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11247 QUEENS BLVD STE 206, FOREST HILLS, NY 11375-7421
(800) 200-8196
Mailing address
11247 QUEENS BLVD STE 206, FOREST HILLS, NY 11375-7421
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
309346
NY
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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