Provider Demographics
NPI:1619565942
Name:TRUDOC LLC
Entity Type:Organization
Organization Name:TRUDOC LLC
Other - Org Name:TRUDOC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-652-5576
Mailing Address - Street 1:712 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2070
Mailing Address - Country:US
Mailing Address - Phone:347-652-5576
Mailing Address - Fax:
Practice Address - Street 1:1187 MAIN AVE STE 1F
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:347-652-5576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-03
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0825425Medicaid