Provider Demographics
NPI:1265543227
Name:RUFFINI, JOHN JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JUSTIN
Last Name:RUFFINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2210
Mailing Address - Country:US
Mailing Address - Phone:610-521-2111
Mailing Address - Fax:610-521-3048
Practice Address - Street 1:8 MORTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2210
Practice Address - Country:US
Practice Address - Phone:610-521-2111
Practice Address - Fax:610-521-3048
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040917E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
413119OtherAETNA
180010184OtherRR MEDICARE
6424863BOtherCIGNA
P531346OtherOXFORD
PA193899OtherIBC
36784002OtherDAVIS VISION
P50682013OtherMULTIPLAN
PA31269BOtherKEYSTONE MERCY HEALTH PLA
PA001637554001Medicaid
PA009153600OtherIBC/KEYSTONE HMO
P531346OtherOXFORD
413119OtherAETNA