Provider Demographics
NPI:1487304788
Name:RAFAELIN, AKWASIBA R
Entity type:Individual
Prefix:
First Name:AKWASIBA
Middle Name:R
Last Name:RAFAELIN
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 1:1111 MIDLAND AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6335
Mailing Address - Country:US
Mailing Address - Phone:917-602-6554
Mailing Address - Fax:
Practice Address - Street 1:1111 MIDLAND AVE APT 3N
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6335
Practice Address - Country:US
Practice Address - Phone:917-602-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist