Provider Demographics
NPI:1386674810
Name:DAVIS, RAPHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:
Last Name:DAVIS
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:NEW YORK SPINE AND BRAIN SURGERY
Mailing Address - Street 2:HSC T12 RM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-1213
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:24 RESEARCH WAY SUITE 200
Practice Address - Street 2:NEW YORK SPINE AND BRAIN SURGERY
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-1213
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150592207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01018111Medicaid
NY4286750OtherAETNA
NY96D48OtherEMPIRE BC.BS
NY01018111Medicaid
NY96D48OtherEMPIRE BC.BS