MEDICARE: DOVID RUDOMIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist		NY

General Provider Information

NPI Number	:	1073093019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOVID RUDOMIN

Provider Business Mailing Address
First Line	:	1318 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5311
Country	:	US
Telephone Number	:	917-757-1779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2102
Country	:	US
Telephone Number	:	917-757-1779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/26/2024

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Directions to “ DOVID RUDOMIN ” Practice Location

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