Healthcare Provider Details

I. General information

NPI: 1316070071
Provider Name (Legal Business Name): RUFO CHUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH STREET
BROOKLYN NY
11215
US

IV. Provider business mailing address

506 6TH STREET
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5870
  • Fax:
Mailing address:
  • Phone: 718-780-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number215149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: