Provider Demographics
NPI:1518967199
Name:RAIFMAN, LEONARD IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:IRWIN
Last Name:RAIFMAN
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 1:1000 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0934
Mailing Address - Country:US
Mailing Address - Phone:212-734-8821
Mailing Address - Fax:212-734-9615
Practice Address - Street 1:1000 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0934
Practice Address - Country:US
Practice Address - Phone:212-734-8821
Practice Address - Fax:212-734-9615
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110236106OtherRAILROAD MEDICARE
NY0730576OtherCIGNA
NY133128491OtherTAX ID
NY164052OtherELDER PLAN
NYPC654OtherCENTER CARE
NYOC1735OtherHEALTHNET
NY00656051Medicaid
NY0M089POtherHIP
NY110008479OtherUNITED HEATHCARE
NYNP263OtherOXFORD HEALTH PLANS
NY009599 99OtherGHI
NY070932OtherAETNA
NY121245 A20OtherHEALTHFIRST
NYOC1735OtherHEALTHNET
NY070932OtherAETNA