Provider Demographics
NPI:1225340136
Name:RF MEDICAL PRACTICE
Entity Type:Organization
Organization Name:RF MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RABEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-622-1037
Mailing Address - Street 1:12418 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3235
Mailing Address - Country:US
Mailing Address - Phone:718-622-1037
Mailing Address - Fax:718-559-6939
Practice Address - Street 1:7568 187TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1726
Practice Address - Country:US
Practice Address - Phone:718-785-9239
Practice Address - Fax:718-559-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237316-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03328489Medicaid
NYG100043008Medicare PIN