Provider Demographics
NPI:1538152517
Name:RUDOLPH M SADA, MD
Entity type:Organization
Organization Name:RUDOLPH M SADA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:MUNTU
Authorized Official - Last Name:SADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-434-0026
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14095-0656
Mailing Address - Country:US
Mailing Address - Phone:716-434-0026
Mailing Address - Fax:716-434-6454
Practice Address - Street 1:521 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3201
Practice Address - Country:US
Practice Address - Phone:716-514-5853
Practice Address - Fax:716-434-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120789207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00362390Medicaid
NY4906609OtherINDEPENDENT HEALTH ASSOCI
NY00010153901OtherUNIVERA
NY000507174001OtherBC & BS OF WESTERN NY
NY000507174001OtherBC & BS OF WESTERN NY
NY4906609OtherINDEPENDENT HEALTH ASSOCI