Mira Rafailov

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

309346 Issued in NY

Practice address

11247 Queens Blvd Ste 206
Forest Hills, NY 11375-7421

Phone

(800) 200-8196

NPI assigned

Mar 29, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SJ All Medical PC

  • Clinical Neurophysiology Physician
  • Valley Stream, NY
  • NPI 1750793642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1841994183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD STE 206",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD STE 206",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757421",
            "telephone_number": "800-200-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFAILOV",
        "first_name": "MIRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moris Rabanipour, M.D.
• Lisa Rabinovich, LMSW
• Jaya Rachwani Parshotam
• Jacek Radomski, PTA
• Rafael Yaakobov Family Health NP PC
• Roni Rafailov
• Lyubov Rafailova, PHARM.D.
• Mohiba Rafiqi
• Diann Eliana Rahim, OTR/L
• Abu Sayed MD Mizanur Rahman

• Adult Health Nurse Practitioner in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.