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General NPI Number Information
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NPI Number | 1497218762
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Entity Type | Organization
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Legal Business Name | RUDOY MEDICAL PC
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 2644 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-3303
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Country | US
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Telephone | 917-684-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 2644 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-3303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALEX MICHELSON
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Credential |
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Telephone | 917-684-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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