Provider Demographics
NPI:1912938671
Name:KUDRYK, ALEXANDER BASIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:BASIL
Last Name:KUDRYK
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:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 UNION AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3063
Practice Address - Country:US
Practice Address - Phone:908-685-1818
Practice Address - Fax:908-685-8225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05346900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE60660Medicare UPIN
NJKU599555Medicare ID - Type Unspecified