Provider Demographics
NPI:1265424600
Name:ROFRANO, SUSAN O (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:O
Last Name:ROFRANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 RAILROAD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2719
Mailing Address - Country:US
Mailing Address - Phone:631-589-7088
Mailing Address - Fax:631-589-7089
Practice Address - Street 1:229 RAILROAD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2719
Practice Address - Country:US
Practice Address - Phone:631-589-7088
Practice Address - Fax:631-589-7089
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00688601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ53401Medicare UPIN