Provider Demographics
NPI:1326016155
Name:RUDNICK, JOSEPH Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:Y
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 1:615 ROUTE 146A
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1606
Mailing Address - Country:US
Mailing Address - Phone:518-371-4610
Mailing Address - Fax:518-371-8307
Practice Address - Street 1:615 ROUTE 146A
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1606
Practice Address - Country:US
Practice Address - Phone:518-371-4610
Practice Address - Fax:518-371-8307
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1125061208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C58575Medicare UPIN
NY51869BMedicare PIN