Provider Demographics
NPI:1134468622
Name:CHARACH, JUDY (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:CHARACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 OCEAN PKWY
Mailing Address - Street 2:APT 4A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4055
Mailing Address - Country:US
Mailing Address - Phone:347-707-3088
Mailing Address - Fax:
Practice Address - Street 1:1180 OCEAN PKWY
Practice Address - Street 2:APT 4A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4055
Practice Address - Country:US
Practice Address - Phone:347-707-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8039631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist