Provider Demographics
NPI:1316163298
Name:RUTTNER, YOSEF MEIR (DPM)
Entity type:Individual
Prefix:DR
First Name:YOSEF
Middle Name:MEIR
Last Name:RUTTNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 88TH ST
Mailing Address - Street 2:11A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2351
Mailing Address - Country:US
Mailing Address - Phone:917-902-9763
Mailing Address - Fax:
Practice Address - Street 1:519 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2131
Practice Address - Country:US
Practice Address - Phone:732-734-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00264300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8585601Medicaid
NJ046741Medicare ID - Type Unspecified