Yakutilov, Rafael

Yakutilov, Rafael is an individual health care provider with primary practice located at 15 Beach 105Th St , Rockaway Park NY 11694-2640. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Yakutilov, Rafael can be contacted via phone (718) 474-0023.

Contact Information

Primary practice address
15 Beach 105Th St Rockaway Park NY 11694-2640
Phone: (718) 474-0023
Fax: (718) 474-2033
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 229375 New York

Profile Details

NPI number 1003811720
LBN Legal business name Yakutilov, Rafael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Jan 30th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003811720 NPPES
New York MEDICAID 02574349

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