Provider Demographics
NPI:1881969004
Name:RAFTOPOL, CAROLINE M (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:RAFTOPOL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1791
Mailing Address - Country:US
Mailing Address - Phone:845-896-7730
Mailing Address - Fax:845-896-0273
Practice Address - Street 1:969 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1791
Practice Address - Country:US
Practice Address - Phone:845-896-7730
Practice Address - Fax:845-896-0273
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015522363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04964307Medicaid