Healthcare Provider Details

I. General information

NPI: 1982416848
Provider Name (Legal Business Name): RUDINEY JEFERSON DARUGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FLATBUSH AVE UNIT 503
BROOKLYN NY
11226-3101
US

IV. Provider business mailing address

815 FLATBUSH AVE UNIT 503
BROOKLYN NY
11226-3101
US

V. Phone/Fax

Practice location:
  • Phone: 407-536-1134
  • Fax: 260-235-5077
Mailing address:
  • Phone: 407-536-1134
  • Fax: 260-235-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number11053063
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number11053063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: