Healthcare Provider Details

I. General information

NPI: 1083691414
Provider Name (Legal Business Name): HARTFORD PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ASYLUM AVE FL 1
HARTFORD CT
06105-2475
US

IV. Provider business mailing address

999 ASYLUM AVE FIRST FLR SUITE 111
HARTFORD CT
06105-2416
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-8026
  • Fax: 860-523-7622
Mailing address:
  • Phone: 860-523-8026
  • Fax: 860-523-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT DAVID RUTSTEIN
Title or Position: PARTNER
Credential: DPM
Phone: 860-523-8026