Provider Demographics
NPI:1588701908
Name:YUDIS, CARMENCITA B (MD)
Entity type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:B
Last Name:YUDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMENCITA
Other - Middle Name:
Other - Last Name:SORIANO-YUDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:PATHOLOGY DEPARTMENT MSC 37
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-1669
Mailing Address - Fax:718-270-3331
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:PATHOLOGY DEPARTMENT BOX 37
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1669
Practice Address - Fax:718-270-3331
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131635207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50I871Medicare ID - Type Unspecified
NYF74316Medicare UPIN