MEDICARE: OLUSANYA RUFAI MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1063078426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLUSANYA RUFAI MEDICAL PC

Provider Business Mailing Address
First Line	:	1143 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5532
Country	:	US
Telephone Number	:	718-693-4121
Fax Number	:	347-663-9403

Provider Business Practice Location Address
First Line	:	1143 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5532
Country	:	US
Telephone Number	:	718-693-4121
Fax Number	:	347-663-9403

Authorized Official
Title or Position	:	CEO
Name	:	DR. OLUSANYA RUFAI
Credential	:	MD
Telephone Number	:	718-693-4121

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	05/11/2019

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