Provider Demographics
NPI:1053484402
Name:BARBOLINI, RUDDI EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:RUDDI
Middle Name:EDWARD
Last Name:BARBOLINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-2881
Mailing Address - Fax:716-839-2882
Practice Address - Street 1:4575 MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-2881
Practice Address - Fax:716-839-2882
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019804 1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9311387OtherINDEPENDENT HEALTH
NY000626504002OtherBLUE CROSS BLUE SHIELD
RA0035Medicare ID - Type Unspecified