1790871846 NPI number — DR. SAMI A RAPHAEL MD

Table of content: DR. SAMI A RAPHAEL MD (NPI 1790871846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790871846 NPI number — DR. SAMI A RAPHAEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAPHAEL
Provider First Name:
SAMI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1790871846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 PINE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-282-2388
Provider Business Mailing Address Fax Number:
716-282-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 PINE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-282-2388
Provider Business Practice Location Address Fax Number:
716-282-0036
Provider Enumeration Date:
10/05/2006

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: 208D00000X , with the licence number:  197756 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00010144401 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000523508001 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4668201 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6008322 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01541620 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426003495 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6407333 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010065541 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1977560 . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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