=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285917385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH I RUFO RPA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2011
-----------------------------------------------------
Last Update Date | 04/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 E 72ND ST STE 409
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1284
-----------------------------------------------------
Fax | 212-288-8260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1284
-----------------------------------------------------
Fax | 212-288-8260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 015130
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------