Provider Demographics
NPI:1649206418
Name:BRUDNICKI, ADELE (MD)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:BRUDNICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1510
Mailing Address - Country:US
Mailing Address - Phone:239-949-0999
Mailing Address - Fax:
Practice Address - Street 1:13 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1510
Practice Address - Country:US
Practice Address - Phone:203-994-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT336252085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131800Medicaid
NY17F241Medicare PIN
NY01131800Medicaid