Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 217476 | NY |
NPI | 1740283233 |
---|---|
Provider Name | Dr. Theodore Rafael |
First Address | White Plains, NY 10602-0253 |
Second Address | Valhalla, NY 10595-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 13/06/2013 |