Provider Demographics
NPI:1457400913
Name:RUDICK, ALBERT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOSEPH
Last Name:RUDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A. JOSEPH
Other - Middle Name:
Other - Last Name:RUDICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:150 BROADWAY
Mailing Address - Street 2:RM 1401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4378
Mailing Address - Country:US
Mailing Address - Phone:212-233-2344
Mailing Address - Fax:212-732-9453
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:STE 1800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-233-2344
Practice Address - Fax:212-732-9453
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161376207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01081465Medicaid
NY133436348OtherMANY
NY05E711Medicare ID - Type Unspecified