MEDICARE: VSEVOLOD G RUDOY MD

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	2084P0800X	Psychiatry Physician	222147	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	:	1619920113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VSEVOLOD G RUDOY MD

Provider Business Mailing Address
First Line	:	PO BOX 350186
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-0186
Country	:	US
Telephone Number	:	718-522-3600
Fax Number	:	718-522-3667

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 1510
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-0103
Country	:	US
Telephone Number	:	718-522-3600
Fax Number	:	718-522-3667

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/13/2026

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