MEDICARE: DR. RICHARD JAY RUDERMAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DI015224	NJ

General Provider Information

NPI Number	:	1255543450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JAY RUDERMAN D.M.D.

Provider Business Mailing Address
First Line	:	500 PIERMONT RD
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2845
Country	:	US
Telephone Number	:	201-768-3513
Fax Number	:	201-768-5762

Provider Business Practice Location Address
First Line	:	500 PIERMONT RD
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2845
Country	:	US
Telephone Number	:	201-768-3513
Fax Number	:	201-768-5762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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