Provider Demographics
NPI:1336174945
Name:ENGELBACH, LUDMILA MARIA (MD)
Entity type:Individual
Prefix:MS
First Name:LUDMILA
Middle Name:MARIA
Last Name:ENGELBACH
Suffix:
Gender:F
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:PO BOX 19
Mailing Address - Street 2:1 ROBERT WOOD JOHNSON PLACE, MEB 212
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1928
Mailing Address - Country:US
Mailing Address - Phone:732-235-8120
Mailing Address - Fax:732-235-4661
Practice Address - Street 1:1140 ROUTE 72 WEST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2412
Practice Address - Country:US
Practice Address - Phone:609-978-8900
Practice Address - Fax:609-978-3176
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ36604171W00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2067307Medicaid
NJP00953436OtherR R MCR
199694Medicare PIN
NJ2067307Medicaid
NJP00953436OtherR R MCR