Provider Demographics
NPI:1245378488
Name:JUDD, STEPHEN P (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:JUDD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934-2112
Mailing Address - Country:US
Mailing Address - Phone:908-234-9259
Mailing Address - Fax:908-725-9803
Practice Address - Street 1:1130 US HIGHWAY 202
Practice Address - Street 2:BUILDING E
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1490
Practice Address - Country:US
Practice Address - Phone:908-725-9595
Practice Address - Fax:908-725-9803
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA001797002251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091005Medicare ID - Type UnspecifiedMEDICARE ID