Provider Demographics
NPI:1972753085
Name:JOHNSON, JUDITH J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 IVY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-1007
Mailing Address - Country:US
Mailing Address - Phone:845-778-4702
Mailing Address - Fax:
Practice Address - Street 1:515 IVY HILL RD
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1007
Practice Address - Country:US
Practice Address - Phone:845-778-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561395-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse