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General NPI Number Information
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NPI Number | 1083988299
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Entity Type | Organization
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Legal Business Name | LISA ROSNER RUTKOVSKY, MD. PC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 14223 BOOTH MEMORIAL AVE
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City | FLUSHING
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State | NY
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Zip | 11355-5343
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Country | US
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Telephone | 718-460-9776
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Fax | 347-368-6486
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Provider Business Mailing Address
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Address Line | 14223 BOOTH MEMORIAL AVE
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City | FLUSHING
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State | NY
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Zip | 11355-5343
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Country | US
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Telephone | 718-460-9776
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Fax | 347-368-6486
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Authorized Official
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Title or Position | PEDIATRIC CARDIOLOGY
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Name | DR. LISA ROSNER RUTKOVSKY
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Credential | MD. PC
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Telephone | 718-460-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 151517
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License Number State | NY
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