Provider Demographics
NPI:1467582643
Name:PRICE, JUDITH B (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:B
Last Name:PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LENAPE CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2677
Mailing Address - Country:US
Mailing Address - Phone:908-464-3636
Mailing Address - Fax:908-464-6711
Practice Address - Street 1:5 LYONS MALL
Practice Address - Street 2:PMB 342
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1928
Practice Address - Country:US
Practice Address - Phone:908-464-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05044500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6035906Medicaid
NJ6035906Medicaid
NJE59463Medicare UPIN