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General NPI Number Information
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NPI Number | 1831354513
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Entity Type | Individual
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Provider Name | MARYAM RAFAEL AGHALAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 97-12 63RD DRIVE SUITE 1-B
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City | REGO PARK
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State | NY
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Zip | 11374-2445
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Country | US
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Telephone | 718-897-7430
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Fax | 718-896-0062
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Provider Business Mailing Address
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Address Line | 97-12 63RD DRIVE SUITE 1-B
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City | REGO PARK
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State | NY
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Zip | 11374-2445
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Country | US
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Telephone | 718-897-7430
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Fax | 718-896-0062
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 263923
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License Number State | NY
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