Provider Demographics
NPI:1629004635
Name:DIMARCO, JUDITH A (RNFNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:A
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:RNFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1321
Mailing Address - Country:US
Mailing Address - Phone:315-343-2590
Mailing Address - Fax:315-343-4197
Practice Address - Street 1:42 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1321
Practice Address - Country:US
Practice Address - Phone:315-343-2590
Practice Address - Fax:315-343-4197
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332019363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816155Medicaid
NYF332019OtherLICENSE
NYMD1236214OtherDEA
E15705Medicare UPIN
NY01816155Medicaid