MEDICARE: MICHAEL C RUDDY 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	174400000X	Specialist	MA31313	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0305250000	OTHER	NJ	AMERIHEALTH
2	08515008	OTHER	NJ	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1K7020	OTHER	NJ	HEALTH NET
5	3144306	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1831138015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C RUDDY M.D.

Provider Business Mailing Address
First Line	:	88 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE 203
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1100
Country	:	US
Telephone Number	:	609-750-7330
Fax Number	:	609-750-7336

Provider Business Practice Location Address
First Line	:	88 PRINCETON HIGHTSTOWN RD
Second Line	:	SUITE 203
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1100
Country	:	US
Telephone Number	:	609-750-7330
Fax Number	:	609-750-7336

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHAEL C RUDDY M.D.” Practice Location

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