Provider Demographics
NPI:1568850162
Name:ABRAMS, JUDITH (LAC BCN PA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LAC BCN PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N CAYUGA ST
Mailing Address - Street 2:SUITE 342
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4329
Mailing Address - Country:US
Mailing Address - Phone:607-277-7713
Mailing Address - Fax:607-277-7713
Practice Address - Street 1:215 N CAYUGA ST
Practice Address - Street 2:SUITE 342
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4329
Practice Address - Country:US
Practice Address - Phone:607-277-7713
Practice Address - Fax:607-277-7713
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000260171100000X
NY002016-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist