Active NPI
Tatyana Ruderman, M.D.
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1093701377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 218176
- Practice address
- 5410 15TH Ave
Brooklyn, NY 11219-4321 - Phone
- (718) 436-0771
- Fax
- (718) 436-8118
- NPI assigned
- Sep 22, 2005
- Reactivated
- Apr 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 218176 | NY | Primary |
Addresses
Primary practice location
5410 15TH Ave
Brooklyn, NY 11219-4321
Mailing address
5410 15TH Ave
Brooklyn, NY 11219-4321
Phone (718) 436-0771
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02110589 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 218176 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1093701377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5410 15TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112194321",
"telephone_number": "718-436-0771",
"fax_number": "718-436-8118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5410 15TH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112194321",
"telephone_number": "718-436-0771",
"fax_number": "718-436-8118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDERMAN",
"first_name": "TATYANA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-22",
"last_updated": "2019-02-26",
"deactivation_date": "2006-03-24",
"reactivation_date": "2006-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "218176",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02110589",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.