Provider Demographics
NPI:1629383955
Name:RUDDY, ROSE A (ACNP)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:A
Last Name:RUDDY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 BLAUVELT RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2007
Mailing Address - Country:US
Mailing Address - Phone:917-748-6117
Mailing Address - Fax:
Practice Address - Street 1:262 BLAUVELT RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2007
Practice Address - Country:US
Practice Address - Phone:917-748-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY485038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse