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NPI Code Detail

MEDICARE: RUDY INNOCENT

MEDICARE: RUDY INNOCENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2104100000XSocial Worker

General Provider Information

NPI Number : 1831975523
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUDY INNOCENT
Provider Business Mailing Address
First Line : 1847 MOTT AVE STE 2
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4220
Country : US
Telephone Number : 718-337-6800
Fax Number :
Provider Business Practice Location Address
First Line : 1847 MOTT AVE STE 2
Second Line :
City : FAR ROCKAWAY
State : NY
Zip : 11691-4220
Country : US
Telephone Number : 718-337-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2023
Last Update Date : 09/07/2023

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Directions to “ RUDY INNOCENT ” Practice Location

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