Provider Demographics
NPI:1467989418
Name:ROONEY, JUDY L (APN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:L
Last Name:ROONEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1105
Mailing Address - Country:US
Mailing Address - Phone:201-289-4076
Mailing Address - Fax:
Practice Address - Street 1:171 ELMORA AVE FL 3
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1169
Practice Address - Country:US
Practice Address - Phone:908-289-2239
Practice Address - Fax:908-289-2239
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00701600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics