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DR. JASON MARC RUDOLPH PSY.D.
NPI 1174404016
Psychologist - Clinical in Wainscott, NY

Active since September 09, 2025
48 SOUTH BREEZE DRIVE, WAINSCOTT, NY 11975(917) 750-8400 Get Directions Write a Review

NPPES record last updated: September 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jason Marc Rudolph Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JASON MARC RUDOLPH PSY.D. (NPI 1174404016) is an individual clinical provider in Wainscott, New York, licensed in New York (017306) and active in the NPI registry since September 2025.

NPPES Registry Identity

NPI1174404016
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. JASON MARC RUDOLPHCredential: PSY.D.
Location Address48 SOUTH BREEZE DRIVEWainscott, NY 11975
Mailing AddressPo Box 1006Wainscott, NY 11975-1006 · (917) 750-8400
Phone(917) 750-8400
Sole ProprietorNo
Enumeration DateSeptember 9, 2025
NPPES CertifiedAugust 27, 2025
✔ NPI 1174404016 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
Licenses✔ Licensed in NY · 017306✔ Licensed in CA · 35868
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
48 SOUTH BREEZE DRIVE, Wainscott, NY 11975
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jason Rudolph's NPI number?

The NPI number for Jason Rudolph is 1174404016. It was assigned to this individual provider in the NPPES registry on September 9, 2025.

Where is Jason Rudolph located?

Jason Rudolph practices at 48 South Breeze Drive, Wainscott, NY 11975. The listed phone number is (917) 750-8400.

What is Jason Rudolph's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Jason Rudolph was last updated on September 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.