Healthcare Provider Details

I. General information

NPI: 1366831737
Provider Name (Legal Business Name): DAHLIA RAFII MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E SHORE RD
GREAT NECK NY
11024-1543
US

IV. Provider business mailing address

528 E SHORE RD
GREAT NECK NY
11024-1543
US

V. Phone/Fax

Practice location:
  • Phone: 516-987-7691
  • Fax:
Mailing address:
  • Phone: 516-987-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262422
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: