Provider Demographics
NPI:1417295478
Name:YUDANOV, ALEKSEY (RN)
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:YUDANOV
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8684 20TH AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3931
Mailing Address - Country:US
Mailing Address - Phone:646-427-0543
Mailing Address - Fax:
Practice Address - Street 1:8684 20TH AVE APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3931
Practice Address - Country:US
Practice Address - Phone:646-427-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664353163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417295478Medicaid