MEDICARE: MR. LEONARD RUDORFER

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	1041C0700X	Clinical Social Worker	PR021627-1	NY

General Provider Information

NPI Number	:	1790865533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD RUDORFER

Provider Business Mailing Address
First Line	:	3924 AVE T
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3924 AVE T
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5028
Country	:	US
Telephone Number	:	718-473-5726
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/14/2009

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