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General NPI Number Information
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NPI Number | 1679844401
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Entity Type | Organization
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Legal Business Name | ADA RUDERMAN MEDICAL PC
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 1208 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-4302
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Country | US
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Telephone | 718-368-2699
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-4302
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Country | US
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Telephone | 718-368-2699
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADA RUDERMAN
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Credential | MD
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Telephone | 718-368-2699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 205782
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License Number State | NY
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