Provider Demographics
NPI:1437584539
Name:ASSOULINE, JUDA
Entity Type:Individual
Prefix:
First Name:JUDA
Middle Name:
Last Name:ASSOULINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3064
Mailing Address - Country:US
Mailing Address - Phone:732-403-6703
Mailing Address - Fax:732-364-1393
Practice Address - Street 1:1401 KNOLL RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3064
Practice Address - Country:US
Practice Address - Phone:732-403-6703
Practice Address - Fax:732-364-1393
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care