Provider Demographics
NPI:1760429518
Name:UY, JUDALYN KAYE BLANCO (PT)
Entity Type:Individual
Prefix:
First Name:JUDALYN KAYE
Middle Name:BLANCO
Last Name:UY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDALYN KAYE
Other - Middle Name:R
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 W CHURCH ST
Mailing Address - Street 2:APT#4
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1743
Mailing Address - Country:US
Mailing Address - Phone:201-233-3811
Mailing Address - Fax:
Practice Address - Street 1:544 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3334
Practice Address - Country:US
Practice Address - Phone:973-759-2046
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01074900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist