Provider Demographics
NPI:1598904013
Name:RAFAILOV, DANIL ISAKOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIL
Middle Name:ISAKOVICH
Last Name:RAFAILOV
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 1:12314 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2710
Mailing Address - Country:US
Mailing Address - Phone:718-441-6060
Mailing Address - Fax:718-441-6060
Practice Address - Street 1:12314 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2710
Practice Address - Country:US
Practice Address - Phone:718-441-6060
Practice Address - Fax:718-441-6060
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250-780-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine