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1376690305 NPI number — LESLIE ANN RUDOLPH RPAC

NPI Number: 1376690305
Health Care Provider/Practitioner: LESLIE ANN RUDOLPH RPAC

Information about “1376690305” NPI (LESLIE ANN RUDOLPH RPAC) exists in 1376690305 in HTML format HTML  |  1376690305 in plain Text format TXT  |  1376690305 in PDF (Portable Document Format) PDF  |  1376690305 in an XML format XML  formats.

NPI Number : 1376690305 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376690305",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUDOLPH",
    "FirstName": "LESLIE",
    "MiddleName": "ANN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RPAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SWENSEN",
    "OtherFirstName": "LESLIE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "575 LEXINGTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW YORK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10022-6102",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "212-746-7576",
    "MailingAddressFaxNumber": "212-746-8383",
    "FirstLinePracticeLocationAddress": "520 E 70TH ST",
    "SecondLinePracticeLocationAddress": "STARR 341",
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10021-9800",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "212-746-7576",
    "PracticeLocationAddressFaxNumber": "212-746-8383",
    "EnumerationDate": "01/04/2007",
    "LastUpdateDate": "07/16/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "007775",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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