Provider Demographics
NPI:1942753967
Name:HOWARD J RUDNICK MD PLLC
Entity Type:Organization
Organization Name:HOWARD J RUDNICK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-716-8315
Mailing Address - Street 1:5030 CHAMPION BLVD
Mailing Address - Street 2:G11-166
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2473
Mailing Address - Country:US
Mailing Address - Phone:561-716-8315
Mailing Address - Fax:
Practice Address - Street 1:5171 LAKE CATALINA DR
Practice Address - Street 2:APT B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2492
Practice Address - Country:US
Practice Address - Phone:561-716-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization