Provider Demographics
NPI:1568427441
Name:ANDERSON, JUDY R (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:STE 115
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3569
Mailing Address - Country:US
Mailing Address - Phone:914-963-0010
Mailing Address - Fax:914-963-8406
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:#310
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-963-0010
Practice Address - Fax:914-963-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-11-29
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Provider Licenses
StateLicense IDTaxonomies
NY202419207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G89216Medicare UPIN
NY09U811Medicare PIN