Provider Demographics
NPI:1013974971
Name:RUDIN, DEBORAH E (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:RUDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4496
Mailing Address - Country:US
Mailing Address - Phone:201-447-6468
Mailing Address - Fax:201-447-3189
Practice Address - Street 1:141 DAYTON ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4496
Practice Address - Country:US
Practice Address - Phone:201-447-6468
Practice Address - Fax:201-447-3189
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59748207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP958608OtherOXFORD#
NJ2K3154OtherHEALTHNET#
NJ3275469OtherAETNA HMO#
NJ4462067OtherAETNA PPO#
NJ123AR1OtherEMPIRE BC/BS#
NJ13126OtherAMERIGROUP#
NJ8221652OtherGHI PPO#
NJ91002075400OtherAMERICHOICE#
NJP00019587OtherRAILROAD MEDICARE#
NJ3275469OtherAETNA HMO#
NJP958608OtherOXFORD#