Healthcare Provider Details

I. General information

NPI: 1558541953
Provider Name (Legal Business Name): RUDOLF KURT MEIER III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 12/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 ROUTE 88 E
BRICK NJ
08724-3265
US

IV. Provider business mailing address

2095 ROUTE 88 E
BRICK NJ
08724-3265
US

V. Phone/Fax

Practice location:
  • Phone: 732-899-4493
  • Fax: 732-899-6801
Mailing address:
  • Phone: 732-899-4493
  • Fax: 732-899-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00205500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MD00205500
License Number StateNJ

VIII. Authorized Official

Name: RUDOLF KURT MEIER III
Title or Position: OWNER
Credential: DPM
Phone: 732-899-4493