Provider Demographics
NPI:1407030489
Name:JULIENNE DUDZIS, DPM
Entity Type:Organization
Organization Name:JULIENNE DUDZIS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-735-0055
Mailing Address - Street 1:153 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1805
Mailing Address - Country:US
Mailing Address - Phone:203-735-0055
Mailing Address - Fax:203-735-0055
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1805
Practice Address - Country:US
Practice Address - Phone:203-735-0055
Practice Address - Fax:203-735-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000583332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004128791Medicaid
CT004128791Medicaid
CT5297130001Medicare NSC
CT480000544Medicare PIN