Provider Demographics
NPI:1982825691
Name:GARSON, JUDD SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDD
Middle Name:
Last Name:GARSON
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JUDD
Other - Middle Name:
Other - Last Name:GARSON
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:16 BELAIRE CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3035
Mailing Address - Country:US
Mailing Address - Phone:732-607-2223
Mailing Address - Fax:732-607-2223
Practice Address - Street 1:4405 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4014
Practice Address - Country:US
Practice Address - Phone:212-568-1500
Practice Address - Fax:212-740-2097
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02558950Medicaid