Provider Demographics
NPI:1902171572
Name:HENGEL, INNA RUDMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:RUDMAN
Last Name:HENGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SERGEY V. BOGDAN M.D. PC
Mailing Address - Street 2:62 KEUNE CT
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1431
Mailing Address - Country:US
Mailing Address - Phone:718-265-7700
Mailing Address - Fax:718-265-7701
Practice Address - Street 1:8686 BAY PKWY STE M4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5193
Practice Address - Country:US
Practice Address - Phone:718-265-7700
Practice Address - Fax:718-265-7701
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267686-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03765955Medicaid