Provider Demographics
NPI:1497839799
Name:YAKOV RAUFOV MEDICAL PC
Entity Type:Organization
Organization Name:YAKOV RAUFOV MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-339-4448
Mailing Address - Street 1:2066 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3835
Mailing Address - Country:US
Mailing Address - Phone:718-339-4448
Mailing Address - Fax:718-339-8159
Practice Address - Street 1:2626 E 14TH ST STE 204
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3968
Practice Address - Country:US
Practice Address - Phone:718-339-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671474Medicaid
NYWET161Medicare ID - Type UnspecifiedMEDICARE