Provider Demographics
NPI:1235156662
Name:SCOTT RUFOLO, O.D., P.C.
Entity Type:Organization
Organization Name:SCOTT RUFOLO, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFOLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-979-6201
Mailing Address - Street 1:3 CUSHING DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1495
Mailing Address - Country:US
Mailing Address - Phone:973-979-6201
Mailing Address - Fax:908-393-2617
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
Practice Address - Country:US
Practice Address - Phone:908-755-2101
Practice Address - Fax:908-755-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 005032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1707604Medicaid
NJU24445Medicare UPIN
NJ1707604Medicaid
NJ565913TW4Medicare ID - Type Unspecified