Provider Demographics
NPI:1427129006
Name:RUDERMAN, MARVIN IRA (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:IRA
Last Name:RUDERMAN
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 1:1099 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7129
Mailing Address - Country:US
Mailing Address - Phone:973-439-7000
Mailing Address - Fax:973-439-7020
Practice Address - Street 1:1099 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7129
Practice Address - Country:US
Practice Address - Phone:973-439-7000
Practice Address - Fax:973-439-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0386832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K5674OtherHEALTHNET PROVIDER ID
NJ449791Medicare ID - Type Unspecified
1K5674OtherHEALTHNET PROVIDER ID