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General NPI Number Information
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NPI Number | 1164913018
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Entity Type | Individual
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Provider Name | IRINA RAFAILOV CEO
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Gender | Female
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Dates
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Enumeration Date | 05/27/2018
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 50 HIGHWAY 9 N., SUITE 208
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City | MORGANVILLE
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State | NJ
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Zip | 07751
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Country | US
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Telephone | 646-785-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 551 ROCKAWAY ST STE 208
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1812
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Country | US
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Telephone | 646-785-4444
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | NY
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