Provider Demographics
NPI:1497496343
Name:RUFO, PEYTON R
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:R
Last Name:RUFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JUSTIN CIR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4290
Mailing Address - Country:US
Mailing Address - Phone:631-456-0708
Mailing Address - Fax:
Practice Address - Street 1:16 JUSTIN CIR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4290
Practice Address - Country:US
Practice Address - Phone:631-456-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical