Basic Information
| Provider Information | |||||||||
| NPI: | 1114970092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUDRIA | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188288363 | ||||||||
| FaxNumber: | 5186973388 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 PROSPECT AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188283327 | ||||||||
| FaxNumber: | 5186978158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1-211095 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04026007325 | 01 | FIDELIS | OTHER | 087073 | 01 | MVP | OTHER | 141503 | 01 | WELLCARE | OTHER | 43363 | 01 | GHI HMO | OTHER | 000492006001 | 01 | BSNENY | OTHER | 1933944 | 01 | UNITED HEALTH CARE | OTHER | 5771C1 | 01 | BC/BS | OTHER | 5999073 | 01 | GHI PPO | OTHER | 080139872 | 01 | RAILROAD CARE | OTHER | 10032025 | 01 | CDPHP | OTHER | 01866077 | 05 | NY | MEDICAID |