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NPI Code Detail

MEDICARE: JACOB D RUDIE DO

MEDICARE: JACOB D RUDIE DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY

General Provider Information

NPI Number : 1861326134
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB D RUDIE DO
Provider Business Mailing Address
First Line : 601 ELMWOOD AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 601 ELMWOOD AVENUE BOX 626
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-276-1350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2026
Last Update Date : 06/10/2026

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Directions to “ JACOB D RUDIE DO” Practice Location

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