Healthcare Provider Details

I. General information

NPI: 1992360762
Provider Name (Legal Business Name): FILIPP YUDITSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PHILIP YUDITSKY MD

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

1400 E 5TH ST
BROOKLYN NY
11230-5605
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-4155
  • Fax:
Mailing address:
  • Phone: 718-316-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP13751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: