Provider Demographics
NPI:1285707273
Name:RUTNER, TORIN W (DMD MD)
Entity type:Individual
Prefix:
First Name:TORIN
Middle Name:W
Last Name:RUTNER
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090
Mailing Address - Country:US
Mailing Address - Phone:908-654-6030
Mailing Address - Fax:908-654-8160
Practice Address - Street 1:552 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3312
Practice Address - Country:US
Practice Address - Phone:908-654-6030
Practice Address - Fax:908-654-8160
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJZSMA07810100208D00000X
NJZZD102055600204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094001Medicare ID - Type Unspecified
V06252Medicare UPIN