Provider Demographics
NPI:1932450467
Name:RAFAILOV, YURIY (DOCTORATE)
Entity Type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:RAFAILOV
Suffix:
Gender:M
Credentials:DOCTORATE
Other - Prefix:DR
Other - First Name:YURIY
Other - Middle Name:
Other - Last Name:RAFAILOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTORATE
Mailing Address - Street 1:702 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1802
Mailing Address - Country:US
Mailing Address - Phone:718-273-7200
Mailing Address - Fax:
Practice Address - Street 1:702 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1802
Practice Address - Country:US
Practice Address - Phone:718-273-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0561471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist