MEDICARE: ADA RUDERMAN M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	205782	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114084399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA RUDERMAN M.D.

Provider Business Mailing Address
First Line	:	1208 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4302
Country	:	US
Telephone Number	:	718-368-2699
Fax Number	:	718-368-2544

Provider Business Practice Location Address
First Line	:	1208 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4302
Country	:	US
Telephone Number	:	718-368-2699
Fax Number	:	718-368-2544

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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