Provider Demographics
NPI:1891156022
Name:DEMBER-PAIGE, JUDITH MARY (OROFACIAL MYOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MARY
Last Name:DEMBER-PAIGE
Suffix:
Gender:F
Credentials:OROFACIAL MYOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1903
Mailing Address - Country:US
Mailing Address - Phone:914-262-9729
Mailing Address - Fax:
Practice Address - Street 1:325 S HIGHLAND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2096
Practice Address - Country:US
Practice Address - Phone:914-302-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist