Healthcare Provider Details

I. General information

NPI: 1457400913
Provider Name (Legal Business Name): ALBERT JOSEPH RUDICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: A. JOSEPH RUDICK M.D.

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY STE 1800
NEW YORK NY
10038-4381
US

IV. Provider business mailing address

150 BROADWAY RM 1401
NEW YORK NY
10038-4378
US

V. Phone/Fax

Practice location:
  • Phone: 212-233-2344
  • Fax: 212-732-9453
Mailing address:
  • Phone: 212-233-2344
  • Fax: 212-732-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number161376
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number161376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: