Healthcare Provider Details

I. General information

NPI: 1376877878
Provider Name (Legal Business Name): FLORIANA RUDNER RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E. RIDGEWOOD AVE SUITE 208
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

1200 E. RIDGEWOOD AVE SUITE 208
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-493-0797
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-493-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00641100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: