Provider Demographics
NPI:1437335817
Name:STANLEY J RUTSTEIN DPM
Entity Type:Organization
Organization Name:STANLEY J RUTSTEIN DPM
Other - Org Name:STANLEY JOEL RUTSTEIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-523-0485
Mailing Address - Street 1:850 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1517
Mailing Address - Country:US
Mailing Address - Phone:860-523-0485
Mailing Address - Fax:860-523-0756
Practice Address - Street 1:850 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1517
Practice Address - Country:US
Practice Address - Phone:860-523-0485
Practice Address - Fax:860-523-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0638000001Medicare NSC
T23209Medicare UPIN
480000289Medicare PIN