Provider Demographics
NPI:1851442966
Name:TUFANO, ROBERT ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:TUFANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRUNO LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7101
Mailing Address - Country:US
Mailing Address - Phone:631-243-3667
Mailing Address - Fax:
Practice Address - Street 1:1000 PARK BLVD
Practice Address - Street 2:REAR ANNEX
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2740
Practice Address - Country:US
Practice Address - Phone:516-795-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01376681Medicaid
NY01376681Medicaid
NY23L851Medicare ID - Type Unspecified