MEDICARE: STANLEY J RUTSTEIN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1437335817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY J RUTSTEIN DPM

Provider Business Mailing Address
First Line	:	850 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1517
Country	:	US
Telephone Number	:	860-523-0485
Fax Number	:	860-523-0756

Provider Business Practice Location Address
First Line	:	850 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1517
Country	:	US
Telephone Number	:	860-523-0485
Fax Number	:	860-523-0756

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STANLEY J RUTSTEIN
Credential	:	DPM
Telephone Number	:	860-523-0485

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	12/13/2010

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