Provider Demographics
NPI:1760584437
Name:RAFAT, PAYAM (DPM)
Entity Type:Individual
Prefix:MR
First Name:PAYAM
Middle Name:
Last Name:RAFAT
Suffix:
Gender:M
Credentials:DPM
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 WEST 4TH STREET
Mailing Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:107 WEST 4TH STREET
Practice Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CTR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005607213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery