1053356006 NPI number — DR. JOAN V JUDGE M.D.

Table of content: DR. JOAN V JUDGE M.D. (NPI 1053356006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053356006 NPI number — DR. JOAN V JUDGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUDGE
Provider First Name:
JOAN
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053356006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9628
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06535-0628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-397-8000
Provider Business Mailing Address Fax Number:
203-389-1540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06850-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-852-2652
Provider Business Practice Location Address Fax Number:
203-299-5606
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  033661 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022040 . This is a "HEALTHNET#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBL073CT01 . This is a "BCBS GROUP#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7938972 . This is a "CIGNA#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0005966034 . This is a "AETNA/USHC#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 713482 . This is a "CONNECTICARE#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001336610P1 . This is a "BLUE CARE FAMILY#" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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