Provider Demographics
NPI:1700835121
Name:DRUDY, ELENA RIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:RIOS
Last Name:DRUDY
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 1:1206 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2414
Mailing Address - Country:US
Mailing Address - Phone:609-597-8087
Mailing Address - Fax:609-597-7192
Practice Address - Street 1:1206 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2414
Practice Address - Country:US
Practice Address - Phone:609-597-8087
Practice Address - Fax:609-597-7192
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08061500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0107662Medicaid
NJ0107662Medicaid
NJ101925Medicare PIN