=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457429151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE CHRISTINE BRUDECKI MA-CCCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 PELHAM PKWY S
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10461-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-918-6271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7030 71ST PL
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-7327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-497-0509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 1827
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------