Provider Demographics
NPI:1518154244
Name:JENNIFER N RUDD MD PC
Entity Type:Organization
Organization Name:JENNIFER N RUDD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-674-5726
Mailing Address - Street 1:90 WASHINGTON STREET
Mailing Address - Street 2:SUITE 213
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1050
Mailing Address - Country:US
Mailing Address - Phone:973-674-5726
Mailing Address - Fax:973-674-5920
Practice Address - Street 1:90 WASHINGTON STREET
Practice Address - Street 2:SUITE 213
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-674-5726
Practice Address - Fax:973-674-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03376500207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty