Provider Demographics
NPI:1508095159
Name:ERGUDER, IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:ERGUDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1501
Mailing Address - Country:US
Mailing Address - Phone:201-265-1159
Mailing Address - Fax:201-262-4749
Practice Address - Street 1:514 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1501
Practice Address - Country:US
Practice Address - Phone:201-265-1159
Practice Address - Fax:201-262-4749
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09173300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0327247Medicaid
NJ262611VT2Medicare PIN