MEDICARE: DR. SHELDON RUDNICKI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	09965	NJ
2	122300000X	Dentist	028152	NY

General Provider Information

NPI Number	:	1225256118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELDON RUDNICKI DDS

Provider Business Mailing Address
First Line	:	215 OLD TAPPAN RD
Second Line	:	2ND FLOOR
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7000
Country	:	US
Telephone Number	:	201-666-8811
Fax Number	:	201-666-8844

Provider Business Practice Location Address
First Line	:	215 OLD TAPPAN RD
Second Line	:	2ND FLOOR
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7000
Country	:	US
Telephone Number	:	201-666-8811
Fax Number	:	201-666-8844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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