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General NPI Number Information
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NPI Number | 1528894268
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Entity Type | Organization
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Legal Business Name | RONI RAFAILOV NP FAMILY HEALTH PC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 21805 GRAND CENTRAL PKWY
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1435
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Country | US
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Telephone | 718-864-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 21805 GRAND CENTRAL PKWY
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONI RAFAILOV
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Credential |
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Telephone | 718-864-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number |
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License Number State |
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