Healthcare Provider Details

I. General information

NPI: 1992732077
Provider Name (Legal Business Name): ALEX RUTTENBERG MSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ALEXANDER RD SUITE 102
PRINCETON NJ
08540-6331
US

IV. Provider business mailing address

707 ALEXANDER RD SUITE 102
PRINCETON NJ
08540-6331
US

V. Phone/Fax

Practice location:
  • Phone: 609-987-8100
  • Fax: 609-987-0574
Mailing address:
  • Phone: 609-987-8100
  • Fax: 609-987-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05334600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: