Provider Demographics
NPI:1164853842
Name:KUDRENETSKY, MICHAEL GERARD (MSED)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERARD
Last Name:KUDRENETSKY
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-0701
Mailing Address - Country:US
Mailing Address - Phone:917-504-2705
Mailing Address - Fax:
Practice Address - Street 1:240 MCLEAN AVE
Practice Address - Street 2:1D
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4454
Practice Address - Country:US
Practice Address - Phone:917-504-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist