Provider Demographics
NPI:1134328818
Name:RAFF, NEIL CHARLES
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:CHARLES
Last Name:RAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16040 78TH RD
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1945
Mailing Address - Country:US
Mailing Address - Phone:914-241-7030
Mailing Address - Fax:914-241-7038
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-7030
Practice Address - Fax:914-241-7038
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0905201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83944Medicare UPIN