MEDICARE: WAYNE ELLIS NARUCKI MD

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	208000000X	Pediatrics Physician	MA07843900	NJ

General Provider Information

NPI Number	:	1902861818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE ELLIS NARUCKI MD

Provider Business Mailing Address
First Line	:	33 LINCOLN AVE
Second Line	:	RED WHEELBARROW PEDIATRICS
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-340-2468
Fax Number	:	201-623-9381

Provider Business Practice Location Address
First Line	:	33 LINCOLN AVE
Second Line	:	RED WHEELBARROW PEDIATRICS
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-340-2468
Fax Number	:	201-623-9381

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/25/2012

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