Provider Demographics
NPI:1043436710
Name:LUDIN, EVAN MARK (MS OTRL CHT)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:MARK
Last Name:LUDIN
Suffix:
Gender:M
Credentials:MS OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELDER DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2320
Mailing Address - Country:US
Mailing Address - Phone:516-650-3555
Mailing Address - Fax:
Practice Address - Street 1:8 ELDER DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2320
Practice Address - Country:US
Practice Address - Phone:516-650-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009005-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist