Basic Information
| Provider Information | |||||||||
| NPI: | 1386601144 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAFAEL ATTIYA, MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 56 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
| FaxNumber: | 6094632757 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094638887 | ||||||||
| FaxNumber: | 6094631116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | ATTIYA | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6094638887 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA07431700 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8992304 | 05 | NJ | MEDICAID | P00019878 | 01 | NJ | RAILROAD MEDICARE | OTHER |