| Rudoy Medical Pc | |
|
2644 E 19th St Brooklyn NY 11235-3303 | |
| (917) 684-4404 | |
| Not Available |
| Full Name | Rudoy Medical Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2644 E 19th St, Brooklyn, New York |
| Authorized Official Name and Position | Alex Michelson (ADMINISTRATOR) |
| Authorized Official Contact | 9176844404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rudoy Medical Pc 2644 E 19th St Brooklyn NY 11235-3303 Ph: () - | Rudoy Medical Pc 2644 E 19th St Brooklyn NY 11235-3303 Ph: (917) 684-4404 |
| NPI Number | 1497218762 |
|---|---|
| Provider Enumeration Date | 04/12/2019 |
| Last Update Date | 04/12/2019 |
| Medicare PECOS PAC ID | 1759615008 |
|---|---|
| Medicare Enrollment ID | O20190620002170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497218762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mian Siddique |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760457188 PECOS PAC ID: 6406848613 Enrollment ID: I20040330001373 |
| Provider Name | Constance Ann Grey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881717668 PECOS PAC ID: 4688636574 Enrollment ID: I20041103001072 |
| Provider Name | Vsevolod G Rudoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619920113 PECOS PAC ID: 1052327020 Enrollment ID: I20060228000572 |
| Provider Name | Stephanie L English |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265503726 PECOS PAC ID: 6507923695 Enrollment ID: I20090317000078 |
| Provider Name | Yakov Semenov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750579777 PECOS PAC ID: 3274663133 Enrollment ID: I20100621000052 |
| Provider Name | Reagan O Anusionwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346492105 PECOS PAC ID: 7012145055 Enrollment ID: I20140121000031 |
| Provider Name | Mark M Zimmermann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275782179 PECOS PAC ID: 9638397300 Enrollment ID: I20140822000715 |
| Provider Name | Wilmot Lambert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003121674 PECOS PAC ID: 7315088945 Enrollment ID: I20150601001768 |
| Provider Name | Lesego A Goba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871047894 PECOS PAC ID: 1355612961 Enrollment ID: I20170731003586 |
| Provider Name | Celal Gurol Erbay |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659380202 PECOS PAC ID: 6507828548 Enrollment ID: I20180207001616 |
| Provider Name | Tessa Anastasia Zompanis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730636473 PECOS PAC ID: 9436400504 Enrollment ID: I20180928002163 |
| Provider Name | Mark Ilyagu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073994711 PECOS PAC ID: 8820340151 Enrollment ID: I20181015000980 |
| Provider Name | Desiree P Hopkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588144364 PECOS PAC ID: 9830436732 Enrollment ID: I20190131000641 |
| Provider Name | John Flynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497156939 PECOS PAC ID: 6002159670 Enrollment ID: I20190522001940 |
| Provider Name | Olena Zakharova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841734324 PECOS PAC ID: 7214212471 Enrollment ID: I20191009002576 |
| Provider Name | Mariya Shavulskiy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982257523 PECOS PAC ID: 1456683960 Enrollment ID: I20191104001108 |
| Provider Name | Christine L Chollak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619519717 PECOS PAC ID: 2365874781 Enrollment ID: I20191122001122 |
| Provider Name | Bethany A Malugin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295285120 PECOS PAC ID: 1759660871 Enrollment ID: I20210308001403 |
| Provider Name | Amy Beth Mcdonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134667181 PECOS PAC ID: 9436436284 Enrollment ID: I20210706001764 |
| Provider Name | Shahruma Islam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942874771 PECOS PAC ID: 3577956366 Enrollment ID: I20220129000125 |
| Provider Name | Becca K Spaulding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760799852 PECOS PAC ID: 5496140014 Enrollment ID: I20220317002423 |
| Provider Name | Stacey Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245794387 PECOS PAC ID: 1456786912 Enrollment ID: I20220411000044 |
| Provider Name | Hope Eseoghene Okoroh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801955661 PECOS PAC ID: 8325388622 Enrollment ID: I20220829003113 |
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