Healthcare Provider Details

I. General information

NPI: 1528166956
Provider Name (Legal Business Name): JUDITH MARIE ARCHER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVE & 100TH ST MOUNT SINAI HOSPITAL
NEW YORK NY
10029
US

IV. Provider business mailing address

1363 EAST 49TH STREET
BROOKLYN NY
11234-2105
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8095
  • Fax:
Mailing address:
  • Phone: 718-377-2628
  • Fax: 718-677-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF3042951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: