Healthcare Provider Details

I. General information

NPI: 1255274486
Provider Name (Legal Business Name): OLUWASEYITAN SAMUEL RUFAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

V. Phone/Fax

Practice location:
  • Phone: 631-726-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: