Provider Demographics
NPI:1891846218
Name:RUDEWICZ, ROBERT JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:RUDEWICZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2123
Mailing Address - Country:US
Mailing Address - Phone:716-684-1010
Mailing Address - Fax:716-836-2995
Practice Address - Street 1:5429 BROADWAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2123
Practice Address - Country:US
Practice Address - Phone:716-684-1010
Practice Address - Fax:716-684-1011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002795213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1100783OtherTAX ID-LANCASTER
NY000507615001OtherBLUE CROSS-BUFFALO
NY00010254201OtherUNIVERA-BUFFALO
NY16-1140534OtherTAX ID-BUFFALO
NYCF7829OtherRAILROAD MEDICARE-BUFFALO
NY00010254202OtherUNIVERA-LANCASTER
NY005076153OtherBLUE CROSS-LANCASTER
NYCF7099OtherRAILRAD MEDICAR-LANCASTER
NY00010254202OtherUNIVERA-LANCASTER
NYCF7829OtherRAILROAD MEDICARE-BUFFALO
NYB50535Medicare PIN