Healthcare Provider Details

I. General information

NPI: 1871643304
Provider Name (Legal Business Name): THOMAS C RUTAN RN, APN, C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST SUITE 7100
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

20 MIDSUMMER DR
OLD BRIDGE NJ
08857-2712
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2400
  • Fax:
Mailing address:
  • Phone: 732-607-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number26NC08521200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: