Provider Demographics
NPI:1790171353
Name:RUDNICK, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22029 STATE ROAD 7 STE 1
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4200
Mailing Address - Country:US
Mailing Address - Phone:561-923-0905
Mailing Address - Fax:561-443-2823
Practice Address - Street 1:22029 STATE ROAD 7 STE 1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4200
Practice Address - Country:US
Practice Address - Phone:561-923-0905
Practice Address - Fax:561-443-2823
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139044207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103613400Medicaid