Healthcare Provider Details

I. General information

NPI: 1346287620
Provider Name (Legal Business Name): RUDOLPH F. TADDONIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WESTCHESTER AVE SUITE 316
WHITE PLAINS NY
10604-2907
US

IV. Provider business mailing address

4 WESTCHESTER PARK DR STE 320
WHITE PLAINS NY
10604-3497
US

V. Phone/Fax

Practice location:
  • Phone: 914-288-0045
  • Fax: 914-288-0065
Mailing address:
  • Phone: 914-517-7981
  • Fax: 914-686-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number032861
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number112892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: