Provider Demographics
NPI:1609906924
Name:RAPHAEL J. OSHEROFF, M.D.' F.A.C.P., P.C.
Entity Type:Organization
Organization Name:RAPHAEL J. OSHEROFF, M.D.' F.A.C.P., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-967-4646
Mailing Address - Street 1:639 SINCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2643
Mailing Address - Country:US
Mailing Address - Phone:718-966-7940
Mailing Address - Fax:718-966-4382
Practice Address - Street 1:639 SINCLAIR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2643
Practice Address - Country:US
Practice Address - Phone:718-966-7940
Practice Address - Fax:718-966-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175535-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
69F202Medicare ID - Type Unspecified
B92715Medicare UPIN