1811349467 NPI number — HARTFORD PODIATRY GROUP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811349467 NPI number — HARTFORD PODIATRY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTFORD PODIATRY GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811349467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 ASYLUM AVE FIRST FLR
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-523-8026
Provider Business Mailing Address Fax Number:
860-523-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2049 SILAS DEANE HWY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-563-1900
Provider Business Practice Location Address Fax Number:
860-563-1902
Provider Enumeration Date:
07/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RUTSTEIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
860-523-8026

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  P00167 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: P00167 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004162476 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007162476 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083691414 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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