Provider Demographics
NPI:1528390416
Name:RUDNICKI, MARIE ELENA
Entity Type:Individual
Prefix:MRS
First Name:MARIE ELENA
Middle Name:
Last Name:RUDNICKI
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 1:1155 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3105
Mailing Address - Country:US
Mailing Address - Phone:631-667-5030
Mailing Address - Fax:631-667-0766
Practice Address - Street 1:1155 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3105
Practice Address - Country:US
Practice Address - Phone:631-667-5030
Practice Address - Fax:631-667-0766
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080103284327031183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician