Provider Demographics
NPI:1861418030
Name:RAFALIN, SAMUEL (MD, FACOG)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:RAFALIN
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48263
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4863
Mailing Address - Country:US
Mailing Address - Phone:212-319-5535
Mailing Address - Fax:845-782-6914
Practice Address - Street 1:210 CENTRAL PARK S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1428
Practice Address - Country:US
Practice Address - Phone:212-319-5535
Practice Address - Fax:845-782-6914
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105177Medicaid
NY0296217OtherGHI
NYN97026OtherHEALTHNET
NYSR082N5910OtherBLUECROSS/BLUESHIELD
NYP2198780OtherOXFORD
NYSR03R94710Medicare ID - Type Unspecified
NYP2198780OtherOXFORD