Provider Demographics
NPI:1114959038
Name:ANDREWS, JUDY A (PA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:A
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-2209
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5430
Practice Address - Country:US
Practice Address - Phone:607-754-7171
Practice Address - Fax:607-754-0290
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02858157Medicaid
NY02858157Medicaid