Provider Demographics
NPI:1578785317
Name:RUDOFOSSI, DANIEL MENACHEM (PSYD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MENACHEM
Last Name:RUDOFOSSI
Suffix:
Gender:M
Credentials:PSYD, PHD
Other - Prefix:PROF
Other - First Name:DANIEL
Other - Middle Name:M
Other - Last Name:RUDOFOSSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, PHD
Mailing Address - Street 1:4 PARK AVE
Mailing Address - Street 2:SUITE 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5339
Mailing Address - Country:US
Mailing Address - Phone:917-836-0635
Mailing Address - Fax:
Practice Address - Street 1:4 PARK AVE
Practice Address - Street 2:SUITE 10F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5339
Practice Address - Country:US
Practice Address - Phone:917-836-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013703DUP103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist