Organization
MGK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL GERARD KUDRENETSKY MSED (PRESIDENT)
(917) 504-2705
Entity
Organization
Contact information
Practice address
66 SUMMER ST UNIT 311, STAMFORD, CT 06901-2316
(917) 504-2705
(203) 428-6200
Mailing address
PO BOX 716, BRONX, NY 10469-0701
(917) 504-2705
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
129466689
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164853842
—
NY
Enumeration date
08/17/2017
Last updated
08/17/2017
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