Provider Demographics
NPI:1821043019
Name:RAFFALLI, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:RAFFALLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MOUNT KISCO MEDICAL GROUP, PC
Mailing Address - Street 2:110 SOUTH BEDFORD ROAD
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3412
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-741-6874
Practice Address - Street 1:MOUNT KISCO MEDICAL GROUP, PC
Practice Address - Street 2:90 SOUTH BEDFORD ROAD
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1371
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-06-13
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Provider Licenses
StateLicense IDTaxonomies
NY185026207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01565273Medicaid
NY35J2106761Medicare PIN
NYG00747Medicare UPIN