Healthcare Provider Details

I. General information

NPI: 1912938671
Provider Name (Legal Business Name): ALEXANDER BASIL KUDRYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 UNION AVE SUITE E
BRIDGEWATER NJ
08807-3063
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-685-1818
  • Fax: 908-685-8225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05346900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: