Provider Demographics
NPI:1750988721
Name:RUFFILLO, LESLIE D (LPN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:RUFFILLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3028
Mailing Address - Country:US
Mailing Address - Phone:347-564-9573
Mailing Address - Fax:
Practice Address - Street 1:8 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3028
Practice Address - Country:US
Practice Address - Phone:347-564-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338694164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse