Provider Demographics
NPI:1083868384
Name:NUNEZ, RANDOLPH LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:LEE
Last Name:NUNEZ
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 1:15 W RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2093
Mailing Address - Country:US
Mailing Address - Phone:201-208-7201
Mailing Address - Fax:231-216-7579
Practice Address - Street 1:15 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2093
Practice Address - Country:US
Practice Address - Phone:201-208-7201
Practice Address - Fax:231-216-7579
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10512200207P00000X, 208000000X
NY250977207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0519847Medicaid