Provider Demographics
NPI:1265674584
Name:JUDGE, LAURA (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1127
Mailing Address - Country:US
Mailing Address - Phone:973-632-7566
Mailing Address - Fax:973-632-7566
Practice Address - Street 1:207 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1127
Practice Address - Country:US
Practice Address - Phone:973-632-7566
Practice Address - Fax:973-632-7566
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000729002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer