| Doctor Name: | MARYAM RAFAEL AGHALAR |
| NPI Number: | 1831354513 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 263923 |
| Business Practice Address: | 97-12 63rd Drive Suite 1-b Rego Park, NY - 113742445 |
| Business Phone Number: | 7188977430 |
| Business Fax Number: | 7188960062 |
| Mailing Address: | 97-12 63rd Drive, Suite 1-b REGO PARK |
| State: | NY |
| Postal Code: | 113742445 |
| Phone Number: | 7188977430 |
| Fax Number: | 7188960062 |
| NPI Enumeration Date: | 07/22/2008 |
| NPI Last Update Date: | 08/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 263923 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |