Provider Demographics
NPI:1285662643
Name:EL-SABROUT, RAFIK A (MD)
Entity Type:Individual
Prefix:
First Name:RAFIK
Middle Name:A
Last Name:EL-SABROUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARRIS BUSHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-794-0996
Mailing Address - Fax:845-794-3347
Practice Address - Street 1:68 HARRIS BUSHVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-0996
Practice Address - Fax:845-794-3347
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265926208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02231170Medicaid
NY02231170Medicaid
NYG97510Medicare UPIN