Provider Demographics
NPI:1477515781
Name:RAFAL, ELYSE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:S
Last Name:RAFAL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2500 ROUTE 347
Mailing Address - Street 2:BUILDING 22A
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-689-0300
Mailing Address - Fax:631-689-1153
Practice Address - Street 1:2500 ROUTE 347
Practice Address - Street 2:BUILDING 22A
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-689-0300
Practice Address - Fax:631-689-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-06-09
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Provider Licenses
StateLicense IDTaxonomies
NY1915433-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF50959Medicare UPIN
NY13U101Medicare PIN