Provider Demographics
NPI:1750642674
Name:RAFAILOVA, FAINA
Entity Type:Individual
Prefix:
First Name:FAINA
Middle Name:
Last Name:RAFAILOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 82ND DR
Mailing Address - Street 2:APT #538
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14110 82ND DR
Practice Address - Street 2:APT #538
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1134
Practice Address - Country:US
Practice Address - Phone:347-935-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist