Healthcare Provider Details

I. General information

NPI: 1306180567
Provider Name (Legal Business Name): FREDERICK RUFFEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROOSEVELT ST
GLEN COVE NY
11542-1943
US

IV. Provider business mailing address

30 ROOSEVELT ST
GLEN COVE NY
11542-1943
US

V. Phone/Fax

Practice location:
  • Phone: 516-759-0008
  • Fax: 516-759-0013
Mailing address:
  • Phone: 516-759-0008
  • Fax: 516-759-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK RUFFEN
Title or Position: OWNER
Credential:
Phone: 516-732-7639