Provider Demographics
NPI:1265497309
Name:SESSENWEIN, JUDITH KAY
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAY
Last Name:SESSENWEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3420
Mailing Address - Country:US
Mailing Address - Phone:518-563-8880
Mailing Address - Fax:518-562-1077
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-562-7777
Practice Address - Fax:518-562-7707
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF360121363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01467147Medicaid
NY01467147Medicaid