Provider Demographics
NPI:1366196750
Name:RAFALOVYCH, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RAFALOVYCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1694
Mailing Address - Country:US
Mailing Address - Phone:718-559-0883
Mailing Address - Fax:718-290-2782
Practice Address - Street 1:424 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1694
Practice Address - Country:US
Practice Address - Phone:718-962-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348732-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily