Provider Demographics
NPI:1063857886
Name:NORMAN, JUDITH ELISSA (CPM, LM, LMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELISSA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:CPM, LM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 W 238TH ST
Mailing Address - Street 2:APT. 6-D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2026
Mailing Address - Country:US
Mailing Address - Phone:917-345-4257
Mailing Address - Fax:
Practice Address - Street 1:474 W 238TH ST
Practice Address - Street 2:APT. 6-D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2026
Practice Address - Country:US
Practice Address - Phone:917-345-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MW00001800176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife