Healthcare Provider Details

I. General information

NPI: 1073857454
Provider Name (Legal Business Name): PATRICIA MAZZETTI-RUDY F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 HOOKER AVE
POUGHKEEPSIE NY
12603-3627
US

IV. Provider business mailing address

211 HURLEY AVE
KINGSTON NY
12401-2400
US

V. Phone/Fax

Practice location:
  • Phone: 845-527-9288
  • Fax:
Mailing address:
  • Phone: 845-339-2804
  • Fax: 845-338-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337448
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: