Healthcare Provider Details

I. General information

NPI: 1124608153
Provider Name (Legal Business Name): SUSAN ANN RUFOLO APN FNP-BC CEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 CAMPUS DR
SOMERSET NJ
08873-1161
US

IV. Provider business mailing address

379 CAMPUS DR
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 732-221-4489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01138600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: