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General NPI Number Information
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NPI Number | 1841565389
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Entity Type | Organization
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Legal Business Name | NADEREH RAFAT, M.D.P.C.
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 153 STEVENS AVE SUITE # 5
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2597
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Country | US
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Telephone | 914-667-1620
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Fax | 914-667-2421
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Provider Business Mailing Address
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Address Line | 153 STEVENS AVE SUITE # 5
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2597
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Country | US
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Telephone | 914-667-1620
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Fax | 914-667-2421
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NADEREH RAFAT
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Credential | M.D.
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Telephone | 914-667-1620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 145111
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License Number State | NY
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