Healthcare Provider Details

I. General information

NPI: 1174767883
Provider Name (Legal Business Name): GREGORY ANTONI RUTKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE DEPT OF ANESTHSIOLOGY MC 2015
FARMINGTON CT
06032
US

IV. Provider business mailing address

99 EAST RIVER DR.
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3600
  • Fax: 860-289-0742
Mailing address:
  • Phone: 860-282-4133
  • Fax: 860-289-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number48194
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number48194
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: