Healthcare Provider Details

I. General information

NPI: 1811349467
Provider Name (Legal Business Name): HARTFORD PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 SILAS DEANE HWY STE 202
ROCKY HILL CT
06067-2332
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 860-563-1900
  • Fax: 860-563-1902
Mailing address:
  • Phone: 860-523-8026
  • Fax: 860-523-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP00167
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP00167
License Number StateCT

VIII. Authorized Official

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