Provider Demographics
NPI:1609171370
Name:NABIL AND REBECCA G RAOOF, MD PC
Entity Type:Organization
Organization Name:NABIL AND REBECCA G RAOOF, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAOOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-642-9855
Mailing Address - Street 1:1390 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2103
Mailing Address - Country:US
Mailing Address - Phone:718-642-9855
Mailing Address - Fax:718-599-0505
Practice Address - Street 1:1390 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2103
Practice Address - Country:US
Practice Address - Phone:718-642-9855
Practice Address - Fax:718-599-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237054Medicaid
NY00237518Medicaid
NYB12489Medicare UPIN
NY320571Medicare PIN
NY298231Medicare PIN
NYB12967Medicare UPIN