Healthcare Provider Details

I. General information

NPI: 1780596353
Provider Name (Legal Business Name): RAFAELA JANFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WIMBLETON LN
GREAT NECK NY
11023-1336
US

IV. Provider business mailing address

14 WIMBLETON LN
GREAT NECK NY
11023-1336
US

V. Phone/Fax

Practice location:
  • Phone: 516-813-8190
  • Fax:
Mailing address:
  • Phone: 516-813-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2094958261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: