Healthcare Provider Details

I. General information

NPI: 1629256664
Provider Name (Legal Business Name): VRUDIK MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 E 85TH ST APT 4-A
NEW YORK NY
10028-0440
US

IV. Provider business mailing address

7 E 85TH ST APT 4-A
NEW YORK NY
10028-0440
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-0825
  • Fax:
Mailing address:
  • Phone: 212-249-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number238234
License Number StateNY

VIII. Authorized Official

Name: VLADIMIR RUDIK
Title or Position: OWNER
Credential: M.D.,D.O.,PH.D.
Phone: 917-892-9525