Provider Demographics
NPI:1326113465
Name:JUCO, JUDY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:M
Last Name:JUCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 E MAIN ST
Mailing Address - Street 2:SUITE106
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2158
Mailing Address - Country:US
Mailing Address - Phone:973-586-4111
Mailing Address - Fax:973-586-8466
Practice Address - Street 1:95 E MAIN ST
Practice Address - Street 2:SUITE106
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2158
Practice Address - Country:US
Practice Address - Phone:973-586-4111
Practice Address - Fax:973-586-8466
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA034259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJU645646Medicare ID - Type Unspecified
NJE68704Medicare UPIN