Provider Demographics
NPI:1811349467
Name:HARTFORD PODIATRY GROUP LLC
Entity type:Organization
Organization Name:HARTFORD PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-523-8026
Mailing Address - Street 1:999 ASYLUM AVE FIRST FLR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2416
Mailing Address - Country:US
Mailing Address - Phone:860-523-8026
Mailing Address - Fax:860-523-7622
Practice Address - Street 1:2049 SILAS DEANE HWY STE 202
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2332
Practice Address - Country:US
Practice Address - Phone:860-563-1900
Practice Address - Fax:860-563-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00167332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004162476Medicaid
CT007162476Medicaid
CT1083691414OtherCIGNA
CT1083691414OtherCIGNA
CTC01774Medicare PIN
CT0744660002Medicare NSC
CTC01774Medicare PIN