Provider Demographics
NPI:1316128333
Name:KURIAKOSE, JUDY
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BRISBANE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3808
Mailing Address - Country:US
Mailing Address - Phone:516-216-1864
Mailing Address - Fax:
Practice Address - Street 1:2 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1519
Practice Address - Country:US
Practice Address - Phone:516-327-8976
Practice Address - Fax:516-327-0041
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704998Medicaid