=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851442966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT ANDREW TUFANO D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 PORTION RD
-----------------------------------------------------
City | LAKE RONKONKOMA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-981-1333
-----------------------------------------------------
Fax | 631-981-2326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 BRUNO LN
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-243-3667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 187554
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------