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:
Health care specialties
| Specialty | Code | License # | 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 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003811720 | NPPES |
| New York | MEDICAID | 02574349 |
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