Provider Demographics
NPI:1538185723
Name:KULK, JUDITH A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:KULK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2220
Mailing Address - Country:US
Mailing Address - Phone:914-949-6612
Mailing Address - Fax:914-949-6612
Practice Address - Street 1:4662 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3055
Practice Address - Country:US
Practice Address - Phone:914-738-7100
Practice Address - Fax:914-738-9249
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2E4651Medicare ID - Type UnspecifiedMEDICARE ID#
NYP43931Medicare UPIN