Provider Demographics
NPI:1386631489
Name:DULTZ, RACHEL PAULA
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:PAULA
Last Name:DULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:EAST WINDSOR MEDICAL COMMONS
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-688-2700
Mailing Address - Fax:609-688-2701
Practice Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:EAST WINDSOR MEDICAL COMMONS
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-688-2700
Practice Address - Fax:609-688-2701
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05914700174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7755601Medicaid
G78258Medicare UPIN
NJ7755601Medicaid
015527AEBMedicare Oscar/Certification