Healthcare Provider Details

I. General information

NPI: 1013974971
Provider Name (Legal Business Name): DEBORAH E RUDIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DAYTON ST
RIDGEWOOD NJ
07450-4496
US

IV. Provider business mailing address

141 DAYTON ST
RIDGEWOOD NJ
07450-4496
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-6468
  • Fax: 201-447-3189
Mailing address:
  • Phone: 201-447-6468
  • Fax: 201-447-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA59748
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: