Provider Demographics
NPI:1326230350
Name:FREDERICK RUFRANO MDFACPPC
Entity Type:Organization
Organization Name:FREDERICK RUFRANO MDFACPPC
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:RUFRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-759-5011
Mailing Address - Street 1:15 GLEN ST
Mailing Address - Street 2:101
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2782
Mailing Address - Country:US
Mailing Address - Phone:516-759-5011
Mailing Address - Fax:516-656-0660
Practice Address - Street 1:15 GLEN ST
Practice Address - Street 2:101
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2782
Practice Address - Country:US
Practice Address - Phone:516-759-5011
Practice Address - Fax:516-656-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
07F981Medicare PIN
E87227Medicare UPIN
WEK331Medicare PIN