Healthcare Provider Details

I. General information

NPI: 1053402370
Provider Name (Legal Business Name): NABIL RAOOF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 PENNSYLVANIA AVENUE
BROOKLYN NY
11239
US

IV. Provider business mailing address

14 PHEASANT HILL LANE
OLD BROOKVILLE NY
11545
US

V. Phone/Fax

Practice location:
  • Phone: 718-642-9855
  • Fax:
Mailing address:
  • Phone: 516-671-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number127162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: