Provider Demographics
NPI:1063078426
Name:OLUSANYA RUFAI MEDICAL PC
Entity type:Organization
Organization Name:OLUSANYA RUFAI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-693-4121
Mailing Address - Street 1:1143 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5532
Mailing Address - Country:US
Mailing Address - Phone:718-693-4121
Mailing Address - Fax:347-663-9403
Practice Address - Street 1:1143 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5532
Practice Address - Country:US
Practice Address - Phone:718-693-4121
Practice Address - Fax:347-663-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty