Provider Demographics
NPI:1225390925
Name:RAFAILOV, SIGALIT (MS)
Entity Type:Individual
Prefix:MRS
First Name:SIGALIT
Middle Name:
Last Name:RAFAILOV
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:SIGALIT
Other - Middle Name:
Other - Last Name:BABAEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8046 212TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1015
Mailing Address - Country:US
Mailing Address - Phone:917-515-8166
Mailing Address - Fax:
Practice Address - Street 1:8046 212TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1015
Practice Address - Country:US
Practice Address - Phone:917-515-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency