Healthcare Provider Details

I. General information

NPI: 1134602170
Provider Name (Legal Business Name): DR. RAFID YEASHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14429 NORTHERN BLVD
FLUSHING NY
11354-4230
US

IV. Provider business mailing address

3950 60TH ST APT B20
WOODSIDE NY
11377-3411
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-1515
  • Fax:
Mailing address:
  • Phone: 646-591-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: