Provider Demographics
NPI:1285671651
Name:SHUKLA, MRUDULA S (MD OBGYN)
Entity Type:Individual
Prefix:DR
First Name:MRUDULA
Middle Name:S
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:STE 21
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-262-8777
Mailing Address - Fax:201-262-4693
Practice Address - Street 1:466 OLD HOOK RD
Practice Address - Street 2:STE 21
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-262-8777
Practice Address - Fax:201-262-4693
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02515400NV207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
135383AOGMedicare ID - Type Unspecified
D06232Medicare UPIN