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General NPI Number Information
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NPI Number | 1215213806
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Entity Type | Organization
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Legal Business Name | GOOD HEALTH PSYCHIATRIC SERVICES, PC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 26 COURT ST SUITE 602
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City | BROOKLYN
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State | NY
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Zip | 11242-0103
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Country | US
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Telephone | 347-410-2771
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190936
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City | BROOKLYN
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State | NY
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Zip | 11219-0936
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Country | US
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Telephone | 347-410-2771
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VSEVOLOD RUDOY
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Credential | MD
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Telephone | 347-410-2771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 222147
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License Number State | NY
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