Provider Demographics
NPI:1801860937
Name:LUDWIG, SHELLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:L
Last Name:LUDWIG
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 1:800 W MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2555
Mailing Address - Country:US
Mailing Address - Phone:732-800-8950
Mailing Address - Fax:732-800-8951
Practice Address - Street 1:800 W MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2555
Practice Address - Country:US
Practice Address - Phone:328-008-9507
Practice Address - Fax:732-800-8951
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03617300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54030Medicare UPIN
NJ451614BJBMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID