Provider Demographics
NPI:1225222870
Name:RUFOLO, SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RUFOLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1214
Mailing Address - Country:US
Mailing Address - Phone:908-755-2101
Mailing Address - Fax:908-755-2889
Practice Address - Street 1:160 EAST SECOND ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1214
Practice Address - Country:US
Practice Address - Phone:908-755-2101
Practice Address - Fax:908-755-2889
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 005032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1707604Medicaid
NJ1707604Medicaid
NJ565913TW4Medicare PIN