Healthcare Provider Details

I. General information

NPI: 1043289929
Provider Name (Legal Business Name): JUDY LESLINA ROSS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE KINGS COUNTY HOSPITAL
BROOKLYN NY
11203
US

IV. Provider business mailing address

1404 E 48TH ST
BROOKLYN NY
11234
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3500
  • Fax: 718-245-3601
Mailing address:
  • Phone: 718-338-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331486
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: