Provider Demographics
NPI:1356308829
Name:BROOK, JUDITH T (MD,)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:T
Last Name:BROOK
Suffix:
Gender:F
Credentials:MD,
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Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:STE 518
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-4630
Mailing Address - Fax:516-663-4644
Practice Address - Street 1:378 SYOSSET WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1200
Practice Address - Country:US
Practice Address - Phone:516-921-3900
Practice Address - Fax:516-663-4644
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1004251173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74457Medicare UPIN