Provider Demographics
NPI:1487928933
Name:REUVEN RUDICH MD PC
Entity type:Organization
Organization Name:REUVEN RUDICH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-374-6400
Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-374-6400
Mailing Address - Fax:203-371-6018
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-374-6400
Practice Address - Fax:203-371-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024240207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79760Medicare UPIN