Provider Demographics
NPI:1790837466
Name:KANE, JUDITH PERLSTEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PERLSTEIN
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W WALL ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5284
Mailing Address - Country:US
Mailing Address - Phone:817-488-6371
Mailing Address - Fax:817-488-6452
Practice Address - Street 1:315 W WALL ST
Practice Address - Street 2:STE. 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5284
Practice Address - Country:US
Practice Address - Phone:817-488-6371
Practice Address - Fax:817-488-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG36832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K20ZMedicare UPIN