Healthcare Provider Details

I. General information

NPI: 1619813714
Provider Name (Legal Business Name): JUSTYNA BARBARA RUDNICKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 GRAND CONCOURSE
BRONX NY
10456-3901
US

IV. Provider business mailing address

217 E 7TH ST APT 7N
BROOKLYN NY
11218-2636
US

V. Phone/Fax

Practice location:
  • Phone: 718-681-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number026737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: