Provider Demographics
NPI:1073708269
Name:RAFAEL YAKUTILOV NEUROLOGY, PC
Entity Type:Organization
Organization Name:RAFAEL YAKUTILOV NEUROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUTILOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-474-0023
Mailing Address - Street 1:15 BEACH 105TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2640
Mailing Address - Country:US
Mailing Address - Phone:718-474-0023
Mailing Address - Fax:718-474-2033
Practice Address - Street 1:15 BEACH 105TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2640
Practice Address - Country:US
Practice Address - Phone:718-474-0023
Practice Address - Fax:718-474-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty