MEDICARE: RUOTSI AND BERTOLINO, MD PC

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	207Q00000X	Family Medicine Physician	175439	NY
2	207Q00000X	Family Medicine Physician	180670	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9511968	OTHER	NY	IHA
2	0106422	OTHER	NY	IHA
3	00010152201	OTHER	NY	UNIVERA
4	00026547001	OTHER	NY	UNIVERA
5	0106423	OTHER	NY	IHA
6	00010015801	OTHER	NY	UNIVERA

General Provider Information

NPI Number	:	1639155351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUOTSI AND BERTOLINO, MD PC

Provider Business Mailing Address
First Line	:	5320 MILITARY RD
Second Line	:	SUITE #104
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-297-1153
Fax Number	:	716-297-5458

Provider Business Practice Location Address
First Line	:	5320 MILITARY RD
Second Line	:	SUITE #104
City	:	LEWISTON
State	:	NY
Zip	:	14092-2149
Country	:	US
Telephone Number	:	716-297-1153
Fax Number	:	716-297-5458

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. FRANCINE R WARNER
Credential	:
Telephone Number	:	716-297-1153

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	02/18/2008

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Directions to “RUOTSI AND BERTOLINO, MD PC ” Practice Location

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