Provider Demographics
NPI:1912211061
Name:DUDZINSKI, CHARLES RICHARD
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:DUDZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2160
Mailing Address - Country:US
Mailing Address - Phone:973-595-8180
Mailing Address - Fax:
Practice Address - Street 1:130 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2036
Practice Address - Country:US
Practice Address - Phone:973-962-9313
Practice Address - Fax:973-962-9315
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01110300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist