Provider Demographics
NPI:1831138015
Name:RUDDY, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:RUDDY
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 1:88 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1100
Mailing Address - Country:US
Mailing Address - Phone:609-750-7330
Mailing Address - Fax:609-750-7336
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:609-750-7330
Practice Address - Fax:609-750-7336
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0305250000OtherAMERIHEALTH
NJ08515008OtherCIGNA
NJ1214608Medicaid
NJ1K7020OtherHEALTH NET
NJ3144306OtherAETNA
NJ197734PCLMedicare ID - Type Unspecified
NJC57343Medicare UPIN