Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MA49691 | NJ |
NPI | 1003804196 |
---|---|
Provider Name | Neal Ruda |
First Address | Hazlet, NJ 07730-1663 |
Second Address | Hazlet, NJ 07730-1663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2003405 | (05) | NJ |