Provider Demographics
NPI:1780155796
Name:REFOUA MEDICAL P.C.
Entity type:Organization
Organization Name:REFOUA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REFOUA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-974-3962
Mailing Address - Street 1:12 WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1906
Mailing Address - Country:US
Mailing Address - Phone:914-509-5836
Mailing Address - Fax:914-357-2489
Practice Address - Street 1:935 NORTHERN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-487-0070
Practice Address - Fax:516-487-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05231136Medicaid