Provider Demographics
NPI:1437185345
Name:BUFANO, INGA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:INGA
Middle Name:
Last Name:BUFANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MORRIS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2904
Mailing Address - Country:US
Mailing Address - Phone:732-574-1399
Mailing Address - Fax:732-574-1433
Practice Address - Street 1:1075 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1116
Practice Address - Country:US
Practice Address - Phone:732-574-1399
Practice Address - Fax:732-574-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP001871363AS0400X
NY010967363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ179997OtherMEDICARE PTAN