Provider Demographics
NPI:1720532013
Name:BUDOFF, RISA (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:BUDOFF
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:RISA
Other - Middle Name:
Other - Last Name:RABINOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:40 FENN RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2212
Mailing Address - Country:US
Mailing Address - Phone:860-777-1283
Mailing Address - Fax:
Practice Address - Street 1:40 FENN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2212
Practice Address - Country:US
Practice Address - Phone:860-777-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019700363AM0700X
CT5650363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical