Healthcare Provider Details

I. General information

NPI: 1023048337
Provider Name (Legal Business Name): RUDNITZKY & SHUGAR MDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 JAMES ST SUITE 104
EDISON NJ
08820-3902
US

IV. Provider business mailing address

PO BOX 2407
EDISON NJ
08818-2407
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-6300
  • Fax: 732-494-1028
Mailing address:
  • Phone: 732-494-6300
  • Fax: 732-494-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3001504
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
IdentifierOK9411
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET

VIII. Authorized Official

Name: DR. RONALD A SHUGAR
Title or Position: PARTNER
Credential: MD
Phone: 732-494-6300