MEDICARE: MS. ALEXA PAIGE RUFFINO PA-C

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	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1146548	OTHER		NCCPA

General Provider Information

NPI Number	:	1477037125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXA PAIGE RUFFINO PA-C

Provider Business Mailing Address
First Line	:	18 NEVIN TER
Second Line	:
City	:	MASSAPEQUA PARK
State	:	NY
Zip	:	11762-3518
Country	:	US
Telephone Number	:	516-732-0454
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034
Country	:	US
Telephone Number	:	212-932-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/19/2018

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