Individual provider Active NPI

Glenn Rudner, DPM

  • Anatomic Pathology Physician
  • New York, NY
National Provider Identifier
1184889008
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
246708 Issued in NY
Practice address
1879 Madison Ave
New York, NY 10035-2709
Phone
(212) 423-4500
NPI assigned
Jul 21, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology Physician 207ZP0101X 246708 NY Primary

Addresses

Primary practice location

1879 Madison Ave
New York, NY 10035-2709

Mailing address

1879 Madison Ave
New York, NY 10035-2709
Phone (212) 423-4500

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNY

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
246708NYMDAnatomic Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North General Physician Services PLLC PastSince Jul 1, 2006 Accepting new patients

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1184889008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100352709",
            "telephone_number": "212-423-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100352709",
            "telephone_number": "212-423-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDNER",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NY",
            "license": "246708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.