Provider Demographics
NPI:1942636196
Name:RAFFO, JOHN ANDREW (PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:RAFFO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:611 NORTHERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5208
Mailing Address - Country:US
Mailing Address - Phone:516-723-2663
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5208
Practice Address - Country:US
Practice Address - Phone:516-723-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017067-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant