MEDICARE: MR. MICHAEL RUDNER P.H.

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	183500000X	Pharmacist	27752	NY

General Provider Information

NPI Number	:	1093038572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL RUDNER P.H.

Provider Business Mailing Address
First Line	:	906 CLIFFSIDE AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3048
Country	:	US
Telephone Number	:	516-791-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 MOTT AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3302
Country	:	US
Telephone Number	:	718-327-2559
Fax Number	:

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

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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