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General NPI Number Information
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NPI Number | 1093987018
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Entity Type | Individual
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Provider Name | DR. SALAMON RAFAILOV
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 3071 AVENUE U
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City | BROOKLYN
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State | NY
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Zip | 11229-5122
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Country | US
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Telephone | 718-736-0123
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Fax | 718-743-0425
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Provider Business Mailing Address
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Address Line | 18706 UNION TPKE
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City | FRESH MEADOWS
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State | NY
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Zip | 11366-1705
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Country | US
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Telephone | 178-654-4329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02366600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053916
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License Number State | NY
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