Provider Demographics
NPI:1932345592
Name:YUDIN, YEHUDA LEIB (PT,DPT)
Entity Type:Individual
Prefix:
First Name:YEHUDA
Middle Name:LEIB
Last Name:YUDIN
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LANETT AVE
Mailing Address - Street 2:APT B
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5514
Mailing Address - Country:US
Mailing Address - Phone:646-210-4510
Mailing Address - Fax:
Practice Address - Street 1:616 BEDFORD AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9610
Practice Address - Country:US
Practice Address - Phone:718-797-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist