Provider Demographics
NPI:1932199973
Name:MUROFF, JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MUROFF
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 1:500 PORTION RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4587
Mailing Address - Country:US
Mailing Address - Phone:631-588-0888
Mailing Address - Fax:631-588-1193
Practice Address - Street 1:500 PORTION RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4587
Practice Address - Country:US
Practice Address - Phone:631-588-0888
Practice Address - Fax:631-588-1193
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005902213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526938Medicaid
NY5190360001Medicare NSC
NYU95220Medicare UPIN
NYPH5661Medicare PIN