Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 028991 | NY |
NPI | 1023021532 |
---|---|
Provider Name | Dr. Stanley Rudnicki |
First Address | Poughkeepsie, NY 12601 |
Second Address | Poughkeepsie, NY 12601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |