Provider Demographics
NPI:1922068071
Name:RAFAT, NADEREH (MD,)
Entity Type:Individual
Prefix:DR
First Name:NADEREH
Middle Name:
Last Name:RAFAT
Suffix:
Gender:F
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:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-0536
Mailing Address - Country:US
Mailing Address - Phone:914-667-1620
Mailing Address - Fax:914-667-2421
Practice Address - Street 1:153 STEVENS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2543
Practice Address - Country:US
Practice Address - Phone:914-667-1620
Practice Address - Fax:914-667-2421
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00762107Medicaid
79A912Medicare PIN