Healthcare Provider Details

I. General information

NPI: 1508568411
Provider Name (Legal Business Name): DR. MICHAEL RAFIZADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 W 181ST ST
NEW YORK NY
10033-5002
US

IV. Provider business mailing address

575 W 181ST ST
NEW YORK NY
10033-5002
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-3060
  • Fax:
Mailing address:
  • Phone: 212-342-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number338447
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: