Provider Demographics
NPI:1770601940
Name:CHECO, YUDERQUI J (MD)
Entity type:Individual
Prefix:
First Name:YUDERQUI
Middle Name:J
Last Name:CHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:194 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1212
Mailing Address - Country:US
Mailing Address - Phone:347-813-8587
Mailing Address - Fax:718-404-9117
Practice Address - Street 1:93-20A ROOSEVELT AVENUE
Practice Address - Street 2:SUITE 3A
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7911
Practice Address - Country:US
Practice Address - Phone:718-404-9109
Practice Address - Fax:718-404-9117
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02665465Medicaid