Provider Demographics
NPI:1306183413
Name:CORINNE KAUDERER DPM, LLC
Entity Type:Organization
Organization Name:CORINNE KAUDERER DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAUDERER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-414-1150
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 1:3 HOSPITAL PLZ STE 204
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3084
Practice Address - Country:US
Practice Address - Phone:732-414-1150
Practice Address - Fax:718-236-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1306183413Other272652