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General NPI Number Information
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NPI Number | 1609906924
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Entity Type | Organization
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Legal Business Name | RAPHAEL J. OSHEROFF, M.D.' F.A.C.P., P.C.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 639 SINCLAIR AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2643
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Country | US
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Telephone | 718-966-7940
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Fax | 718-966-4382
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Provider Business Mailing Address
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Address Line | 639 SINCLAIR AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2643
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Country | US
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Telephone | 718-966-7940
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Fax | 718-966-4382
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LAURA UNGER
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Credential |
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Telephone | 718-967-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 175535-1
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License Number State | NY
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