Provider Demographics
NPI:1083988299
Name:LISA ROSNER RUTKOVSKY, MD. PC
Entity Type:Organization
Organization Name:LISA ROSNER RUTKOVSKY, MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ROSNER
Authorized Official - Last Name:RUTKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:718-460-9776
Mailing Address - Street 1:14223 BOOTH MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5343
Mailing Address - Country:US
Mailing Address - Phone:718-460-9776
Mailing Address - Fax:347-368-6486
Practice Address - Street 1:14223 BOOTH MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5343
Practice Address - Country:US
Practice Address - Phone:718-460-9776
Practice Address - Fax:347-368-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151517174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty