Healthcare Provider Details

I. General information

NPI: 1235156662
Provider Name (Legal Business Name): SCOTT RUFOLO, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 EAST SECOND ST.
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

3 CUSHING DR
BRIDGEWATER NJ
08807-1495
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-2101
  • Fax: 908-755-2889
Mailing address:
  • Phone: 973-979-6201
  • Fax: 908-393-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA 005032
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1707604
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. SCOTT RUFOLO
Title or Position: PRESIDENT
Credential: OD
Phone: 973-979-6201