Provider Demographics
NPI:1619792769
Name:RAPHA PRIMARY CARE LLC
Entity type:Organization
Organization Name:RAPHA PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANNITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIWAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-456-2578
Mailing Address - Street 1:905 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6983
Mailing Address - Country:US
Mailing Address - Phone:917-456-2578
Mailing Address - Fax:
Practice Address - Street 1:6 GRAMATAN AVE STE 605
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3208
Practice Address - Country:US
Practice Address - Phone:917-456-2578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty