Healthcare Provider Details

I. General information

NPI: 1831160837
Provider Name (Legal Business Name): LISA ANN RUML M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BLACKWELL ST
DOVER NJ
07801-2525
US

IV. Provider business mailing address

7 GROVER RD
DOVER NJ
07801-2506
US

V. Phone/Fax

Practice location:
  • Phone: 973-989-3085
  • Fax:
Mailing address:
  • Phone: 973-876-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA67110
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06711000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: