Healthcare Provider Details

I. General information

NPI: 1356318893
Provider Name (Legal Business Name): JUDY HUANG-BULGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 HARTFORD TPKE
VERNON CT
06066-4838
US

IV. Provider business mailing address

PO BOX 3249
VERNON CT
06066-2149
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-2102
  • Fax: 860-870-0890
Mailing address:
  • Phone: 860-872-2289
  • Fax: 860-896-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: