| 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 | 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 | Yakov Semenov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750579777 PECOS PAC ID: 3274663133 Enrollment ID: I20100621000052 |
| Provider Name | John Flynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497156939 PECOS PAC ID: 6002159670 Enrollment ID: I20190522001940 |
| 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 | 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 |
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