Provider Demographics
NPI:1114220126
Name:RUTLEDGE PEDIATRICS
Entity Type:Organization
Organization Name:RUTLEDGE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-624-8510
Mailing Address - Street 1:167 RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8006
Mailing Address - Country:US
Mailing Address - Phone:718-624-8510
Mailing Address - Fax:718-624-8033
Practice Address - Street 1:167 RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8006
Practice Address - Country:US
Practice Address - Phone:718-624-8510
Practice Address - Fax:718-624-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care