Provider Demographics
NPI:1871663518
Name:RUFRANO, FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:RUFRANO
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 1:15 GLEN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2782
Mailing Address - Country:US
Mailing Address - Phone:516-759-5011
Mailing Address - Fax:516-656-0660
Practice Address - Street 1:15 GLEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2782
Practice Address - Country:US
Practice Address - Phone:516-759-5011
Practice Address - Fax:516-656-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164751-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839349Medicaid
NY07F981Medicare PIN
WEK331Medicare ID - Type Unspecified
NY01839349Medicaid