Provider Demographics
NPI:1003093519
Name:REFUA SHLEMA MEDICAL PC
Entity Type:Organization
Organization Name:REFUA SHLEMA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:ILYAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-614-1717
Mailing Address - Street 1:499 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5126
Mailing Address - Country:US
Mailing Address - Phone:347-614-1717
Mailing Address - Fax:
Practice Address - Street 1:499 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5126
Practice Address - Country:US
Practice Address - Phone:347-614-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 245643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909539Medicaid