Provider Demographics
NPI:1952490369
Name:RAFF, AMANDA C (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:RAFF
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 1:18 BAILEY PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1202
Mailing Address - Country:US
Mailing Address - Phone:866-633-8255
Mailing Address - Fax:718-405-8322
Practice Address - Street 1:MONTEFIORE MEDICAL PARK
Practice Address - Street 2:1515 BLONDELL AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215296207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02176167Medicaid
H48377Medicare UPIN