Provider Demographics
NPI:1750320891
Name:RUFFALO, ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RUFFALO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1940
Mailing Address - Country:US
Mailing Address - Phone:973-239-9313
Mailing Address - Fax:973-239-9314
Practice Address - Street 1:265 BROAD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2764
Practice Address - Country:US
Practice Address - Phone:973-429-3001
Practice Address - Fax:973-429-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00407200208100000X
NJMC00374000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRU603100Medicare ID - Type Unspecified
NJT87633Medicare UPIN