Provider Demographics
NPI:1215213806
Name:GOOD HEALTH PSYCHIATRIC SERVICES, PC
Entity Type:Organization
Organization Name:GOOD HEALTH PSYCHIATRIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VSEVOLOD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-410-2771
Mailing Address - Street 1:PO BOX 190936
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-0936
Mailing Address - Country:US
Mailing Address - Phone:347-410-2771
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 602
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:347-410-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2221472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty