Provider Demographics
NPI:1902861818
Name:NARUCKI, WAYNE ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ELLIS
Last Name:NARUCKI
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 1:33 LINCOLN AVE
Mailing Address - Street 2:RED WHEELBARROW PEDIATRICS
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2167
Mailing Address - Country:US
Mailing Address - Phone:201-340-2468
Mailing Address - Fax:201-623-9381
Practice Address - Street 1:33 LINCOLN AVE
Practice Address - Street 2:RED WHEELBARROW PEDIATRICS
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2167
Practice Address - Country:US
Practice Address - Phone:201-340-2468
Practice Address - Fax:201-623-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07843900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics