Provider Demographics
NPI:1649916404
Name:DR. JUDITH MAGLOCZKI, D.O., P.C.
Entity type:Organization
Organization Name:DR. JUDITH MAGLOCZKI, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGLOCZKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-771-7465
Mailing Address - Street 1:132 BERNSTEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-1500
Mailing Address - Country:US
Mailing Address - Phone:773-771-7465
Mailing Address - Fax:
Practice Address - Street 1:300 OLD COUNTRY RD STE 2
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2146
Practice Address - Country:US
Practice Address - Phone:631-405-5544
Practice Address - Fax:800-627-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty