Healthcare Provider Details

I. General information

NPI: 1619958113
Provider Name (Legal Business Name): BENJAMIN S RUDNITSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 FIRE MESA ST STE 110
LAS VEGAS NV
89128-9034
US

IV. Provider business mailing address

2545 S BRUCE ST STE 200
LAS VEGAS NV
89169-1778
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-0090
  • Fax: 702-853-0096
Mailing address:
  • Phone: 702-732-2438
  • Fax: 702-737-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number10816
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: