Healthcare Provider Details

I. General information

NPI: 1285931121
Provider Name (Legal Business Name): JUDY S BRUSTEIN RN, CHPN, MS, GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHARLES LINDBERGH BLVD SUITE 206
UNIONDALE NY
11553-3626
US

IV. Provider business mailing address

4545 E SHEA BLVD SUITE 175
PHOENIX AZ
85028-3074
US

V. Phone/Fax

Practice location:
  • Phone: 866-662-4560
  • Fax: 480-907-2108
Mailing address:
  • Phone: 602-464-5251
  • Fax: 480-907-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number340770
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340770-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: