Provider Demographics
NPI:1376517052
Name:BUDOFF, STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BUDOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W END AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1809
Mailing Address - Country:US
Mailing Address - Phone:908-333-4008
Mailing Address - Fax:908-333-4009
Practice Address - Street 1:135 W END AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1809
Practice Address - Country:US
Practice Address - Phone:908-333-4008
Practice Address - Fax:908-333-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB624602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6661505Medicaid
NJ788671SKUMedicare ID - Type Unspecified
NJ6661505Medicaid