1033258363 NPI number — DIANE RUTKOWSKY M.A.

Table of content: DIANE RUTKOWSKY M.A. (NPI 1033258363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033258363 NPI number — DIANE RUTKOWSKY M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTKOWSKY
Provider First Name:
DIANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

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:
1033258363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 SHERWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOREHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-403-4885
Provider Business Mailing Address Fax Number:
631-425-4670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 N. COUNTRY RD.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MT. SINAI
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-403-4885
Provider Business Practice Location Address Fax Number:
631-425-4670
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  001371-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 14000007431 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: M7571 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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