1184713059 NPI number — DR. RAFIK MONIR ISTAFANOUS M.D.

Table of content: DR. RAFIK MONIR ISTAFANOUS M.D. (NPI 1184713059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184713059 NPI number — DR. RAFIK MONIR ISTAFANOUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISTAFANOUS
Provider First Name:
RAFIK
Provider Middle Name:
MONIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184713059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 CAROL TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07059-5439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-532-8865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 SOUTH ORANGE AVE
Provider Second Line Business Practice Location Address:
E LEVEL ROOM E 1546
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-5054
Provider Business Practice Location Address Fax Number:
873-972-3399
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0802X , with the licence number:  25MA07547500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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