Provider Demographics
NPI:1003270661
Name:RUDNICKI, ANNA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIA
Last Name:RUDNICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:GOLDENS BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10526-0492
Mailing Address - Country:US
Mailing Address - Phone:914-954-3339
Mailing Address - Fax:
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:GOLDENS BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:10526-1204
Practice Address - Country:US
Practice Address - Phone:914-954-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024937102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst