Provider Demographics
NPI:1336216530
Name:KUDLER, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KUDLER
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 1:544 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7523
Mailing Address - Country:US
Mailing Address - Phone:212-988-4812
Mailing Address - Fax:212-988-0686
Practice Address - Street 1:544 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7523
Practice Address - Country:US
Practice Address - Phone:212-988-4812
Practice Address - Fax:212-988-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1439892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS3760OtherOXFORD HEALTH PLAN I.D.
NY162804POtherHIP PRIS NUMBER
NY143989-N01OtherHIP I.D. NUMBER
NY09D541Medicare ID - Type Unspecified
NYA99417Medicare UPIN