MEDICARE: DR. RICHARD RAFAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	163854	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164422689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD RAFAL M.D.

Provider Business Mailing Address
First Line	:	240 E 82ND ST
Second Line	:	12A
City	:	NEW YORK
State	:	NY
Zip	:	10028-2703
Country	:	US
Telephone Number	:	212-939-8062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4338
Country	:	US
Telephone Number	:	718-338-6868
Fax Number	:	718-252-3650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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