Willis, Rudolph
Willis, Rudolph is an individual health care provider with primary practice located at 12 Krotik Pl Irvington Emergent Care And Rehabilitation Center Inc., Irvington NJ 07111-1708. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Willis, Rudolph can be contacted via phone (973) 373-3000.Contact Information
Primary practice address
12 Krotik Pl Irvington Emergent Care And Rehabilitation Center Inc.
Irvington NJ 07111-1708
Phone: (973) 373-3000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MA42750 | New Jersey |
Profile Details
| NPI number | 1104887819 |
|---|---|
| LBN Legal business name | Willis, Rudolph |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2006 |
| Last updated | Feb 6th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104887819 | NPPES |
| New Jersey | MEDICAID | 0887307 |
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