Provider Demographics
NPI:1093716011
Name:RUDNICK, HOWARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JAY
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CHAMPION BLVD.
Mailing Address - Street 2:SUITE G11-166
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-716-8315
Mailing Address - Fax:561-293-8318
Practice Address - Street 1:4600 LINTON BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:844-744-4900
Practice Address - Fax:561-293-8318
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038790207X00000X
FLME38790207X00000X, 207XX0004X, 207XS0106X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044069800Medicaid
FLC75486Medicare UPIN
FL0460260001Medicare NSC
FL044069800Medicaid
FL94023ZMedicare ID - Type UnspecifiedPHYSICIAN MEDICARE NUMBER