Provider Demographics
NPI:1265090674
Name:RUTMAN MEDICAL PLLC
Entity type:Organization
Organization Name:RUTMAN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-207-2684
Mailing Address - Street 1:148 NATURES LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3137
Mailing Address - Country:US
Mailing Address - Phone:917-207-2684
Mailing Address - Fax:
Practice Address - Street 1:148 NATURES LN
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3137
Practice Address - Country:US
Practice Address - Phone:917-207-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty