Provider Demographics
NPI:1548583750
Name:NUDELMAN, LEONID (RPH)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:NUDELMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OCEANA DRIVE WEST
Mailing Address - Street 2:APT. 5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:UM
Mailing Address - Phone:917-916-4186
Mailing Address - Fax:
Practice Address - Street 1:120 OCEANA DR W
Practice Address - Street 2:APT. 5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6659
Practice Address - Country:US
Practice Address - Phone:917-916-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052437-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist