Provider Demographics
NPI:1013095363
Name:MAX RUDANSKY, MD & JACQUES WINTER MD, PC
Entity Type:Organization
Organization Name:MAX RUDANSKY, MD & JACQUES WINTER MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-351-1250
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-351-1250
Mailing Address - Fax:631-351-1321
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-351-1250
Practice Address - Fax:631-351-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN
NYW12061Medicare PIN
NYM 0W120610Medicare PIN