Provider Demographics
NPI:1427131051
Name:VICTOR, RAFAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:DAVID
Last Name:VICTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-851-9001
Mailing Address - Fax:718-853-7349
Practice Address - Street 1:1468 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-851-9001
Practice Address - Fax:718-853-7349
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH2632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00710669Medicaid
0101159OtherAETNA HMO
4289181OtherPPOR POS
NYBKX0245OtherAMERICHOICE
P378135OtherOXFORD
0002239OtherGHI
0C4315OtherHEALTHNET
12159POtherHIP PRIS#
P378135OtherOXFORD
0002239OtherGHI