Provider Demographics
NPI:1992822043
Name:RAFIQUE, ILORA IMAM (MD ,MPH)
Entity type:Individual
Prefix:DR
First Name:ILORA
Middle Name:IMAM
Last Name:RAFIQUE
Suffix:
Gender:F
Credentials:MD ,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2807
Mailing Address - Country:US
Mailing Address - Phone:914-969-1254
Mailing Address - Fax:
Practice Address - Street 1:1469 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5846
Practice Address - Country:US
Practice Address - Phone:347-346-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH20159Medicare UPIN