Healthcare Provider Details

I. General information

NPI: 1285077016
Provider Name (Legal Business Name): ROFEH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 LOOMIS ROAD
LIBERTY NY
12754-3003
US

IV. Provider business mailing address

1478 E 15TH ST
BROOKLYN NY
11230-6602
US

V. Phone/Fax

Practice location:
  • Phone: 845-608-2783
  • Fax: 845-439-3154
Mailing address:
  • Phone: 845-608-2783
  • Fax: 845-439-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number123563
License Number StateNY

VIII. Authorized Official

Name: LAZAR FRUCHTER
Title or Position: DOCTOR
Credential: M.D.
Phone: 845-367-2476