Provider Demographics
NPI:1033112248
Name:KAUDERER, CORINNE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:R
Last Name:KAUDERER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2413
Mailing Address - Country:US
Mailing Address - Phone:718-232-2100
Mailing Address - Fax:718-236-2020
Practice Address - Street 1:7713 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2413
Practice Address - Country:US
Practice Address - Phone:718-232-2100
Practice Address - Fax:718-236-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0039402081S0010X, 208VP0000X, 213ES0131X
NJ25MD00276700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00904430-4Medicaid
NYP40802Medicare PIN
NY00904430-4Medicaid
NJ0907300002Medicare NSC
NYT51256Medicare UPIN
NJ128581Medicare PIN