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General NPI Number Information
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NPI Number | 1619792769
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Entity Type | Organization
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Legal Business Name | RAPHA PRIMARY CARE LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 6 GRAMATAN AVE STE 605
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3208
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Country | US
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Telephone | 917-456-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 905 EVERGREEN CT
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City | NEW WINDSOR
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State | NY
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Zip | 12553-6983
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Country | US
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Telephone | 917-456-2578
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | SANNITTA GIWAH
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Credential | NP
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Telephone | 917-456-2578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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