Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 008567-1 | NY |
NPI | 1154335453 |
---|---|
Provider Name | Dr. Ronald Curtis Fudge |
First Address | Mount Vernon, NY 10552-2321 |
Second Address | East Orange, NJ 07018-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |