Provider Demographics
NPI:1144322611
Name:RUDD, JENNIFER NELL (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NELL
Last Name:RUDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:90 WASHINGTON ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1050
Mailing Address - Country:US
Mailing Address - Phone:973-674-5726
Mailing Address - Fax:973-674-5920
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:SUITE 213
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-674-5726
Practice Address - Fax:973-674-5920
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03376500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3139506Medicaid
D06805Medicare UPIN
NJ3139506Medicaid