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General NPI Number Information
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NPI Number | 1528629326
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Entity Type | Individual
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Provider Name | LIZA G RUDROFF M.ED., TVI
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 85 WASHINGTON AVE LWR
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City | KENMORE
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State | NY
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Zip | 14217-1905
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Country | US
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Telephone | 716-777-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 85 WASHINGTON AVE LWR
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City | KENMORE
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State | NY
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Zip | 14217-1905
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Country | US
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Telephone | 716-777-0870
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 477735101
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1374401191
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License Number State | NY
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