Individual
EDWARD RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
728 N MAIN ST, NEW SQUARE, NY 10977-8916
(845) 354-9300
Mailing address
490 W 187TH ST, APT 4H, NEW YORK, NY 10033-1513
(551) 486-2899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
056060-1
NY
Other
Enumeration date
07/19/2011
Last updated
07/17/2012
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