Provider Demographics
NPI:1376871202
Name:HUMERA, RAFATH KHATOON (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFATH
Middle Name:KHATOON
Last Name:HUMERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1367 RATZER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2429
Mailing Address - Country:US
Mailing Address - Phone:973-333-3875
Mailing Address - Fax:
Practice Address - Street 1:535 GETTY AVE
Practice Address - Street 2:SUITE-3(PARK AVE MEDICAL CENTER)
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2105
Practice Address - Country:US
Practice Address - Phone:973-782-4905
Practice Address - Fax:973-782-4893
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08760600207R00000X
NY256036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine