Provider Demographics
NPI:1639265333
Name:RUTSTEIN, ERIC STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEPHEN
Last Name:RUTSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 GLADES ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-0000
Mailing Address - Country:US
Mailing Address - Phone:561-447-9212
Mailing Address - Fax:561-447-9234
Practice Address - Street 1:2499 GLADES ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-0000
Practice Address - Country:US
Practice Address - Phone:561-447-9212
Practice Address - Fax:561-447-9234
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME709752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7496Medicare ID - Type Unspecified
FLG05650Medicare UPIN