Provider Demographics
NPI:1043580483
Name:RUTBERG, TOBY D BOGERT (OT)
Entity Type:Individual
Prefix:MRS
First Name:TOBY
Middle Name:D BOGERT
Last Name:RUTBERG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STOUTENBURGH DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2053
Mailing Address - Country:US
Mailing Address - Phone:914-475-2160
Mailing Address - Fax:
Practice Address - Street 1:25 STOUTENBURGH DR
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2053
Practice Address - Country:US
Practice Address - Phone:914-475-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02357-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor