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General NPI Number Information
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NPI Number | 1336397686
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Entity Type | Organization
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Legal Business Name | J. R. UDARBE MD P.C.
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 1010 NORTHERN BLVD SUITE 208
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City | GREAT NECK
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State | NY
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Zip | 11021-5306
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Country | US
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Telephone | 516-336-2560
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Fax | 516-336-2561
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Provider Business Mailing Address
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Address Line | 1010 NORTHERN BLVD SUITE 208
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City | GREAT NECK
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State | NY
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Zip | 11021-5306
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Country | US
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Telephone | 516-336-2560
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Fax | 516-336-2561
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DR. JOHN ROBERT UDARBE
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Credential | M.D.
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Telephone | 516-336-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 208198
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 208198
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License Number State | NY
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