Provider Demographics
NPI:1760716542
Name:RUKSHIN, VLADIMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:RUKSHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2028
Mailing Address - Country:US
Mailing Address - Phone:732-264-1933
Mailing Address - Fax:
Practice Address - Street 1:2433 HIGHWAY 516 STE B
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1899
Practice Address - Country:US
Practice Address - Phone:732-617-0033
Practice Address - Fax:866-263-5979
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08756700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ186218Medicare PIN