Healthcare Provider Details

I. General information

NPI: 1023327087
Provider Name (Legal Business Name): JUDY MARILYN IWAOKA MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W END AVE APT 4F
NEW YORK NY
10025-8474
US

IV. Provider business mailing address

840 WEST END AVENUE #4F
NYC NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 212-666-1552
  • Fax:
Mailing address:
  • Phone: 212-666-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number007871-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: