Provider Demographics
NPI:1972924223
Name:RAFFLOER, NICOLE (RPA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RAFFLOER
Suffix:
Gender:F
Credentials:RPA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-354-1600
Practice Address - Fax:516-941-4677
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016637-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant