Provider Demographics
NPI:1639138282
Name:NUDELMAN, MIROSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:
Last Name:NUDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 WHITE PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709
Mailing Address - Country:US
Mailing Address - Phone:914-337-1610
Mailing Address - Fax:914-337-9312
Practice Address - Street 1:329 WHITE PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709
Practice Address - Country:US
Practice Address - Phone:914-337-1610
Practice Address - Fax:914-337-9312
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS226125207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3708660OtherOXFORD
NY0118819OtherGHI
NY02639018Medicaid
NYP3708660OtherBLUE CROSS BLUE SHIELD
NY2623841OtherUNITED HEALTH CARE
NY1211751OtherAETNA HMO
NYP3708660OtherBLUE CROSS BLUE SHIELD