Provider Demographics
NPI:1164913018
Name:RAFAILOV, IRINA (CEO)
Entity type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:RAFAILOV
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ROCKAWAY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1812
Mailing Address - Country:US
Mailing Address - Phone:646-785-4444
Mailing Address - Fax:
Practice Address - Street 1:50 HIGHWAY 9 N.,
Practice Address - Street 2:SUITE 208
Practice Address - City:MORGANVILLE,
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:646-785-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide