Provider Demographics
NPI:1336314723
Name:ISANOV, RAFAEL
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:ISANOV
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 1:4920 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3418
Mailing Address - Country:US
Mailing Address - Phone:718-871-5663
Mailing Address - Fax:718-871-5663
Practice Address - Street 1:4920 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3418
Practice Address - Country:US
Practice Address - Phone:718-871-5663
Practice Address - Fax:718-871-5663
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5061080001Medicare NSC