Provider Demographics
NPI:1548955586
Name:ELLEN KUDROW NP IN PSYCHIATRY AND NP IN FAMILY HEALTH PC
Entity type:Organization
Organization Name:ELLEN KUDROW NP IN PSYCHIATRY AND NP IN FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-376-3029
Mailing Address - Street 1:501 SURF AVE APT 2K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3526
Mailing Address - Country:US
Mailing Address - Phone:561-376-3029
Mailing Address - Fax:
Practice Address - Street 1:501 SURF AVE APT 2K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3526
Practice Address - Country:US
Practice Address - Phone:561-376-3029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty