MEDICARE: DR. CAROLYN MUDRY D.O.

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	207R00000X	Internal Medicine Physician	25MB07841200	NJ

General Provider Information

NPI Number	:	1427013937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN MUDRY D.O.

Provider Business Mailing Address
First Line	:	127 UNION ST
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-4478
Country	:	US
Telephone Number	:	201-444-5200
Fax Number	:	201-444-2399

Provider Business Practice Location Address
First Line	:	127 UNION ST
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-4478
Country	:	US
Telephone Number	:	201-444-5200
Fax Number	:	201-444-2399

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/13/2019

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