Provider Demographics
NPI:1861782237
Name:DUDAIE, RONEN SHEM (MD)
Entity type:Individual
Prefix:DR
First Name:RONEN
Middle Name:SHEM
Last Name:DUDAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1441
Mailing Address - Country:US
Mailing Address - Phone:973-747-5734
Mailing Address - Fax:
Practice Address - Street 1:921 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1441
Practice Address - Country:US
Practice Address - Phone:973-747-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003759207RC0200X
TXQ3359207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine