Provider Demographics
NPI:1164571311
Name:RUDIN, MERRILL STACY
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:STACY
Last Name:RUDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 83RD ST
Mailing Address - Street 2:APT.5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4345
Mailing Address - Country:US
Mailing Address - Phone:212-452-3001
Mailing Address - Fax:
Practice Address - Street 1:211 E 60TH ST
Practice Address - Street 2:SUITE A3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1437
Practice Address - Country:US
Practice Address - Phone:212-755-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU29508Medicare UPIN
NYX49131Medicare ID - Type Unspecified