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General NPI Number Information
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NPI Number | 1073093019
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Entity Type | Individual
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Provider Name | DOVID RUDOMIN
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Gender | Male
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1760 E 17TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-2102
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Country | US
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Telephone | 917-757-1779
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 E 28TH ST
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City | BROOKLYN
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State | NY
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Zip | 11210-5311
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Country | US
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Telephone | 917-757-1779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State | NY
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