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General NPI Number Information
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NPI Number | 1649206418
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Entity Type | Individual
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Provider Name | ADELE BRUDNICKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 13 LAKEVIEW RD
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City | BROOKFIELD
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State | CT
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Zip | 06804-1510
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Country | US
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Telephone | 203-994-9099
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Fax |
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Provider Business Mailing Address
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Address Line | 13 LAKEVIEW RD
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City | BROOKFIELD
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State | CT
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Zip | 06804-1510
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Country | US
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Telephone | 239-949-0999
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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 | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 33625
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License Number State | CT
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