Provider Demographics
NPI:1740546043
Name:YUDES-KUZNETSOV, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:YUDES-KUZNETSOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YULIYA
Other - Middle Name:
Other - Last Name:YUDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:917-608-7823
Mailing Address - Fax:
Practice Address - Street 1:833 MOORE ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:917-608-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009967-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist