=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609997451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUDOLF MORGAN D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 W END AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10023-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-595-1100
-----------------------------------------------------
Fax | 212-595-1797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 E 71ST ST 11P
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-885-3246
-----------------------------------------------------
Fax | 212-595-1797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 049506
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------