Provider Demographics
NPI:1821026709
Name:RUDMAN, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:RUDMAN
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 1:1124 E RIDGEWOOD AVE
Mailing Address - Street 2:201 T
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3915
Mailing Address - Country:US
Mailing Address - Phone:201-447-1188
Mailing Address - Fax:201-447-8935
Practice Address - Street 1:1124 E RIDGEWOOD AVE
Practice Address - Street 2:201 T
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3915
Practice Address - Country:US
Practice Address - Phone:201-447-1188
Practice Address - Fax:201-447-8935
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07771200207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085565TGPOtherPTAN
NJ085565TGPOtherPTAN
NJH97642Medicare UPIN