Healthcare Provider Details

I. General information

NPI: 1871658831
Provider Name (Legal Business Name): BRIANA JENNIFER RUDICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLUMBUS CIR FL PH
NEW YORK NY
10019-1412
US

IV. Provider business mailing address

5 COLUMBUS CIR FL PH
NEW YORK NY
10019-1412
US

V. Phone/Fax

Practice location:
  • Phone: 646-756-8282
  • Fax:
Mailing address:
  • Phone: 646-756-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT184465
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number260734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: