Provider Demographics
NPI:1285077016
Name:ROFEH MEDICAL PC
Entity type:Organization
Organization Name:ROFEH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-367-2476
Mailing Address - Street 1:1478 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6602
Mailing Address - Country:US
Mailing Address - Phone:845-608-2783
Mailing Address - Fax:845-439-3154
Practice Address - Street 1:344 LOOMIS ROAD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-3003
Practice Address - Country:US
Practice Address - Phone:845-608-2783
Practice Address - Fax:845-439-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974314Medicaid