MEDICARE: ADA RUDERMAN MEDICAL PC

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	261Q00000X	Clinic/Center	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	:	1679844401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADA RUDERMAN MEDICAL PC

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADA RUDERMAN
Credential	:	MD
Telephone Number	:	718-368-2699

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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