Provider Demographics
NPI:1467563296
Name:ELRAFEI, TAREK (DO)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:ELRAFEI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M106
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-823-9600
Mailing Address - Fax:718-828-1960
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M106
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-823-9600
Practice Address - Fax:718-828-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212011207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI00377Medicare UPIN
NY2Z1451Medicare ID - Type Unspecified