Individual provider Active NPI

Rudiney Jeferson Daruge, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Brooklyn, NY
National Provider Identifier
1982416848
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
11053063 Issued in FL
Practice address
815 Flatbush Ave Unit 503
Brooklyn, NY 11226-3101
Phone
(407) 536-1134
Fax
(260) 235-5077
NPI assigned
Jan 27, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 11053063 FL
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X 11053063 FL Primary

Addresses

Primary practice location

815 Flatbush Ave Unit 503
Brooklyn, NY 11226-3101

Mailing address

815 Flatbush Ave Unit 503
Brooklyn, NY 11226-3101
Phone (407) 536-1134

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

LicenseStateTypeSpecialty
11053063FLMDOral & Maxillofacial Surgery (D.M.D.)

NPI Registry JSON

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1982416848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 FLATBUSH AVE UNIT 503",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112263101",
            "telephone_number": "407-536-1134",
            "fax_number": "260-235-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 FLATBUSH AVE UNIT 503",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112263101",
            "telephone_number": "407-536-1134",
            "fax_number": "260-235-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARUGE",
        "first_name": "RUDINEY JEFERSON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "FL",
            "license": "11053063",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "11053063",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 27, 2025; 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.