Provider Demographics
NPI:1629146113
Name:JUDY R. ANDERSON,M.D.,P.C.
Entity Type:Organization
Organization Name:JUDY R. ANDERSON,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-963-0010
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:STE 310
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202419207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWANK61Medicare PIN