=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568435261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIPPLE MUKUND MARFATIA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2006
-----------------------------------------------------
Last Update Date | 09/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5596 ROUTE 19A
-----------------------------------------------------
City | CASTILE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14427-9757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-493-9230
-----------------------------------------------------
Fax | 585-786-0508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 WYOMING ST
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14569-9523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-786-2769
-----------------------------------------------------
Fax | 585-786-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 224172
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------