Healthcare Provider Details

I. General information

NPI: 1972443760
Provider Name (Legal Business Name): DANIEL RUFFRAGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
UTICA NY
13502-2517
US

IV. Provider business mailing address

2215 GENESEE ST
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-917-9966
  • Fax:
Mailing address:
  • Phone: 315-624-6099
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number773481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: