1114970092 NPI number — INNA KUDRIA MD

Table of content: INNA KUDRIA MD (NPI 1114970092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114970092 NPI number — INNA KUDRIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUDRIA
Provider First Name:
INNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114970092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-8363
Provider Business Mailing Address Fax Number:
518-697-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-3327
Provider Business Practice Location Address Fax Number:
518-697-8158
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1-211095 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04026007325 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 087073 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141503 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43363 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000492006001 . This is a "BSNENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1933944 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5771C1 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5999073 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080139872 . This is a "RAILROAD CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10032025 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01866077 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com