Provider Demographics
NPI:1952347403
Name:RUTOWSKI OF EAST AURORA INC
Entity Type:Organization
Organization Name:RUTOWSKI OF EAST AURORA INC
Other - Org Name:LARWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:RUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-652-1360
Mailing Address - Street 1:597 OAKWOOD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052
Mailing Address - Country:US
Mailing Address - Phone:716-652-1360
Mailing Address - Fax:716-655-0132
Practice Address - Street 1:597 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2333
Practice Address - Country:US
Practice Address - Phone:716-652-1360
Practice Address - Fax:716-655-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 335E00000X, 3336C0004X
NY0084253336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607992Medicaid
NY1952347403Medicaid
2057148OtherPK
2057148OtherPK