Jeffrey Alan Rudolph

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

006419 Issued in NY

Practice address

952 5TH Ave
Suite 2D
New York, NY 10075-1740

Phone

(212) 628-8490

Fax

(212) 628-8496

NPI assigned

Sep 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jeffrey A. Rudolph Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190592000000",
    "number": "1972799955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "952 5TH AVE",
            "address_2": "SUITE 2D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751740",
            "telephone_number": "212-628-8490",
            "fax_number": "212-628-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "952 5TH AVE",
            "address_2": "SUITE 2D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751740",
            "telephone_number": "212-628-8490",
            "fax_number": "212-628-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "JEFFREY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NY",
            "license": "006419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFFREY",
            "last_name": "RUDOLPH",
            "middle_name": "A.",
            "prefix": "DR.",
            "credential": "PSY.D, ABPP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tina Rudolf
• Melanie Rudolfo, CRNA
• Renee V Rudolph-Ramdath
• Diane Carol Rudolph, MD
• Iris Marie Rudolph
• Joanna Carol Rudolph, L M S W
• Leslie Ann Rudolph, RPAC
• Lisa Rudolph, DNP, AGNP-BC
• Shentique Monique Rudolph
• Ann Rudovsky, L.C.S.W.

• Case Management Agency in New York, NY
• Providers in New York, NY by specialty
• Case Management Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.