MEDICARE: REBECCA RAFAEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	357995	NY

General Provider Information

NPI Number	:	1265308290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RAFAEL

Provider Business Mailing Address
First Line	:	26 ALLENWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-2127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MIDDLE NECK RD STE H
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1107
Country	:	US
Telephone Number	:	516-829-3003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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