Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MA01947500 | NJ |
NPI | 1184895963 |
---|---|
Provider Name | Mr. Leon S Rutkowski |
First Address | Mahwah, NJ 07430-1540 |
Second Address | Mahwah, NJ 07430-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C59661 | (02) | NJ |