Provider Demographics
NPI:1447205323
Name:THEODORA S. BUDNIK, M.D.
Entity Type:Organization
Organization Name:THEODORA S. BUDNIK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUDNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-473-1112
Mailing Address - Street 1:243 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:845-473-1112
Mailing Address - Fax:845-486-4008
Practice Address - Street 1:243 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1172
Practice Address - Country:US
Practice Address - Phone:845-473-1112
Practice Address - Fax:845-486-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1305981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1305981OtherLICENSE