Healthcare Provider Details

I. General information

NPI: 1790881027
Provider Name (Legal Business Name): REBECCA RAOOF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 PENNSYLVANIA AVE
BROOKLYN NY
11239-2103
US

IV. Provider business mailing address

14 PHEASANT HILL LN
GLEN HEAD NY
11545-2115
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 Number128062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: