Provider Demographics
NPI:1962479303
Name:RUTSTEIN, STANLEY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:RUTSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:J
Other - Last Name:RUTSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP000385213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004061800Medicaid
0638000001Medicare NSC
480000289Medicare ID - Type Unspecified
CT004061800Medicaid