Provider Demographics
NPI:1538483011
Name:CHRISTMAS, RUDOLPH E (LPN)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:E
Last Name:CHRISTMAS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-0703
Mailing Address - Country:US
Mailing Address - Phone:347-584-7038
Mailing Address - Fax:347-449-6324
Practice Address - Street 1:3424 ELY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2636
Practice Address - Country:US
Practice Address - Phone:347-584-7038
Practice Address - Fax:347-449-6324
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210568164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse