Provider Demographics
NPI:1033518717
Name:ARTESSA, JUDITH (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:ARTESSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-3521
Mailing Address - Country:US
Mailing Address - Phone:315-824-1372
Mailing Address - Fax:
Practice Address - Street 1:4715 E LAKE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-3521
Practice Address - Country:US
Practice Address - Phone:315-824-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002604-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist