Provider Demographics
NPI:1316935406
Name:SADLER, RUFUS EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:EDGAR
Last Name:SADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 BEDFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2415
Mailing Address - Country:US
Mailing Address - Phone:718-364-0100
Mailing Address - Fax:718-295-9220
Practice Address - Street 1:3750 THIRD AVE
Practice Address - Street 2:DMG
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2102
Practice Address - Country:US
Practice Address - Phone:718-588-0100
Practice Address - Fax:646-568-2982
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA45747OtherLICENSE NUMBER
NY00909462OtherMEDICAID PROVIDER NUMBER
NY163783OtherLICENSE
NY53D771OtherMEDICARE PROVIDER NUMBER
NY53D771OtherMEDICARE PROVIDER NUMBER