Provider Demographics
NPI:1639155351
Name:RUOTSI AND BERTOLINO, MD PC
Entity Type:Organization
Organization Name:RUOTSI AND BERTOLINO, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-297-1153
Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-1153
Mailing Address - Fax:716-297-5458
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:SUITE #104
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-297-1153
Practice Address - Fax:716-297-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180670207Q00000X
NY175439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9511968OtherIHA
NY0106422OtherIHA
NY00010152201OtherUNIVERA
NY00026547001OtherUNIVERA
NY0106423OtherIHA
NY00010015801OtherUNIVERA
NY00026547001OtherUNIVERA
NY00010015801OtherUNIVERA
NYE45144Medicare UPIN
NYE34072Medicare UPIN
NYRB5955Medicare PIN