Healthcare Provider Details

I. General information

NPI: 1639134588
Provider Name (Legal Business Name): IZUKA P UDOM-RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IZUKA P UDOM MD

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 GUY R BREWER BLVD
JAMAICA NY
11434
US

IV. Provider business mailing address

8515 MAIN ST
BRIARWOOD NY
11435-1879
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-978-6888
Mailing address:
  • Phone: 516-459-3329
  • Fax: 718-978-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number169783
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number169783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: