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NPI Code Detail

MEDICARE: GRACE RUDNICK

MEDICARE: GRACE RUDNICK
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1962194829
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE RUDNICK
Provider Business Mailing Address
First Line : 600 E 233RD ST
Second Line :
City : BRONX
State : NY
Zip : 10466-2604
Country : US
Telephone Number : 718-920-2060
Fax Number :
Provider Business Practice Location Address
First Line : 600 E 233RD ST
Second Line :
City : BRONX
State : NY
Zip : 10466-2604
Country : US
Telephone Number : 718-920-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 01/10/2026

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Directions to “ GRACE RUDNICK ” Practice Location

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