Provider Demographics
NPI:1528047800
Name:RUFFY, MAURO LEDESMA (MD)
Entity type:Individual
Prefix:DR
First Name:MAURO
Middle Name:LEDESMA
Last Name:RUFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-625-4230
Mailing Address - Fax:718-875-4480
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-625-4230
Practice Address - Fax:718-875-4480
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675572207V00000X
NY112364207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00203392Medicaid
NYC11728Medicare UPIN
NY00203392Medicaid