Provider Demographics
NPI:1306180567
Name:FREDERICK RUFFEN
Entity Type:Organization
Organization Name:FREDERICK RUFFEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-732-7639
Mailing Address - Street 1:30 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1943
Mailing Address - Country:US
Mailing Address - Phone:516-759-0008
Mailing Address - Fax:516-759-0013
Practice Address - Street 1:30 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1943
Practice Address - Country:US
Practice Address - Phone:516-759-0008
Practice Address - Fax:516-759-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty