MEDICARE: AARON RUDDER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1629730718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON RUDDER

Provider Business Mailing Address
First Line	:	1 MOUNTAIN VIEW PL S
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-3112
Country	:	US
Telephone Number	:	845-750-9758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MOUNTAIN VIEW PL S
Second Line	:
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-3112
Country	:	US
Telephone Number	:	845-750-9758
Fax Number	:

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

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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Directions to “ AARON RUDDER ” Practice Location

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