Provider Demographics
NPI:1740275064
Name:CHUDACOFF, RICHARD MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:CHUDACOFF
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1345
Mailing Address - Country:US
Mailing Address - Phone:702-481-8808
Mailing Address - Fax:
Practice Address - Street 1:1561 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1345
Practice Address - Country:US
Practice Address - Phone:702-481-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5869207V00000X
CAG70841207V00000X
VA0101266257207V00000X
NY319212207V00000X
PAMD479668207V00000X
FLME114379207VF0040X
NV12108207VG0400X
NJ25MA10635300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11340275064Medicaid
FL115868400Medicaid