| Kudos Medical Pllc | |
|
304 Genesee St Chittenango NY 13037-1707 | |
| (315) 687-6467 | |
| (315) 251-2240 |
| Full Name | Kudos Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 304 Genesee St, Chittenango, New York |
| Authorized Official Name and Position | Ifechukwude Ojugbeli (OWNER) |
| Authorized Official Contact | 3156876467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kudos Medical Pllc 304 Genesee St Chittenango NY 13037-1707 Ph: (315) 687-6467 | Kudos Medical Pllc 304 Genesee St Chittenango NY 13037-1707 Ph: (315) 687-6467 |
| NPI Number | 1801303532 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 4183962616 |
|---|---|
| Medicare Enrollment ID | O20190208000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801303532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | 209777 (New York) | Primary |
| Provider Name | Ifechukwude O Ojugbeli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710059530 PECOS PAC ID: 7719025840 Enrollment ID: I20091111000166 |
| Provider Name | Diane S Ojugbeli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619088812 PECOS PAC ID: 3577746767 Enrollment ID: I20110325000142 |
| Provider Name | Jessica Dlugolecki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841867603 PECOS PAC ID: 0042613176 Enrollment ID: I20210727000670 |
| Provider Name | Roberta L Countryman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295441640 PECOS PAC ID: 7911372982 Enrollment ID: I20230404002177 |
Lafayette Healthcare Associates Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 304 Genesee Street, Chittenango, NY 13037 Phone: 315-687-6467 Fax: 315-251-2240 |