Provider Demographics
NPI:1881864825
Name:RUTMAN, ABE (BS)
Entity type:Individual
Prefix:MR
First Name:ABE
Middle Name:
Last Name:RUTMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1596
Mailing Address - Country:US
Mailing Address - Phone:917-885-6214
Mailing Address - Fax:914-765-0600
Practice Address - Street 1:575 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1891
Practice Address - Country:US
Practice Address - Phone:914-765-0600
Practice Address - Fax:914-765-0188
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028123183500000X
NY28123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist