Healthcare Provider Details

I. General information

NPI: 1659570372
Provider Name (Legal Business Name): RAFFI HAROUN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 SUNRISE HWY STE 201
MASSAPEQUA PARK NY
11762-2911
US

IV. Provider business mailing address

17 HARBOUR POINT DR
NORTHPORT NY
11768-1568
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-4445
  • Fax:
Mailing address:
  • Phone: 860-839-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52395
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number52409
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number009663
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: