Provider Demographics
NPI:1932124070
Name:BANKS, JUDY L (MD)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:L
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1209
Mailing Address - Country:US
Mailing Address - Phone:973-377-3374
Mailing Address - Fax:973-377-1286
Practice Address - Street 1:256 COLUMBIA TPKE
Practice Address - Street 2:SUITE 212
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1209
Practice Address - Country:US
Practice Address - Phone:973-377-3374
Practice Address - Fax:973-377-1286
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03440700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06744Medicare UPIN