Provider Demographics
NPI:1356425474
Name:RUCHELMAN, TRINA ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:TRINA
Middle Name:ANN
Last Name:RUCHELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TRINA
Other - Middle Name:ANN
Other - Last Name:SULKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:15 CUTTER CT
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-1924
Mailing Address - Country:US
Mailing Address - Phone:732-672-4864
Mailing Address - Fax:609-758-2191
Practice Address - Street 1:HIGHWAY RT. 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-0477
Practice Address - Country:US
Practice Address - Phone:732-431-7577
Practice Address - Fax:732-431-8070
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI208841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8584109Medicaid