Provider Demographics
NPI:1659437473
Name:RUDOLPH, STEVEN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HENRY
Last Name:RUDOLPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 KINGS HWY STE 2-06
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2644
Mailing Address - Country:US
Mailing Address - Phone:718-677-2089
Mailing Address - Fax:718-434-0395
Practice Address - Street 1:3131 KINGS HWY STE 2-06
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-677-2089
Practice Address - Fax:718-434-0395
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1352982084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00933326Medicaid
NY00933326Medicaid
NYB14107Medicare UPIN