Provider Demographics
NPI:1457324568
Name:EMANUELE, JUDY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY ANN
Middle Name:
Last Name:EMANUELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2673
Mailing Address - Country:US
Mailing Address - Phone:631-369-0490
Mailing Address - Fax:631-369-6421
Practice Address - Street 1:1267 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2673
Practice Address - Country:US
Practice Address - Phone:631-369-0490
Practice Address - Fax:631-369-6421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2064032082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP831475OtherOXFORD
NYAA72815OtherMDNY
NY2364740OtherUNITED HEALTHCARE
NY2127965OtherVYTRA
NY206403-8OtherWORKER'S COMPENSATION
NY2127965OtherVYTRA
NY29L341Medicare ID - Type Unspecified