Provider Demographics
NPI:1053664953
Name:RUDZINSKI, TIMOTHY F (BS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:RUDZINSKI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PARK PLACE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-5210
Mailing Address - Country:US
Mailing Address - Phone:518-295-2031
Mailing Address - Fax:
Practice Address - Street 1:113 PARK PLACE
Practice Address - Street 2:SUITE 1
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5210
Practice Address - Country:US
Practice Address - Phone:518-295-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00555784Medicaid