Healthcare Provider Details

I. General information

NPI: 1114079779
Provider Name (Legal Business Name): RUDOLPH JOHN STREEMKE III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COUNTY RD
CRESSKILL NJ
07626-2203
US

IV. Provider business mailing address

135 COUNTY RD
CRESSKILL NJ
07626-2203
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-9393
  • Fax: 201-568-1590
Mailing address:
  • Phone: 201-568-9393
  • Fax: 201-568-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01650800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: