Healthcare Provider Details

I. General information

NPI: 1346528114
Provider Name (Legal Business Name): NECLA KUDRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHURCH ST S STE F206
NEW HAVEN CT
06519-1703
US

IV. Provider business mailing address

47 NUTMEG DR
GREENWICH CT
06831-3211
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-3141
  • Fax: 203-785-2510
Mailing address:
  • Phone: 718-690-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number276495
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberCT47008
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD456462
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: