Provider Demographics
NPI:1033834353
Name:PAMPHILE, RUT NOEMI (FNP)
Entity Type:Individual
Prefix:
First Name:RUT
Middle Name:NOEMI
Last Name:PAMPHILE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6464
Mailing Address - Country:US
Mailing Address - Phone:718-220-7677
Mailing Address - Fax:
Practice Address - Street 1:1351 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1149
Practice Address - Country:US
Practice Address - Phone:203-889-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350535363L00000X
CT12384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY350535OtherOFFICE OF PROFFESIONS - NEW YORK STATE
CT12384OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH