Provider Demographics
NPI:1891778882
Name:RUFFO, JOSEPH D (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:RUFFO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 NORMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1510
Mailing Address - Country:US
Mailing Address - Phone:631-482-8710
Mailing Address - Fax:631-482-8711
Practice Address - Street 1:147 NORMA AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1510
Practice Address - Country:US
Practice Address - Phone:631-482-8710
Practice Address - Fax:631-482-8711
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005680213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU80803Medicare UPIN
NYPB8511Medicare PIN