Provider Demographics
NPI:1871565887
Name:PRUS, DINA (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:PRUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:PRUS-WERTHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:264 BOYDEN AVE
Mailing Address - Street 2:EMPIRE MEDICAL GROUP
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3070
Mailing Address - Country:US
Mailing Address - Phone:973-761-5200
Mailing Address - Fax:973-761-7617
Practice Address - Street 1:264 BOYDEN AVE
Practice Address - Street 2:EMPIRE MEDICAL GROUP
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3070
Practice Address - Country:US
Practice Address - Phone:973-761-5200
Practice Address - Fax:973-761-7617
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69784207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ039112BSDMedicare ID - Type Unspecified
NJG46482Medicare UPIN