Provider Demographics
NPI:1275770059
Name:VON KRUSENSTIERN, LENORE
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:
Last Name:VON KRUSENSTIERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LENORE
Other - Middle Name:
Other - Last Name:SOODAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:302 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7522
Practice Address - Country:US
Practice Address - Phone:617-566-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology