Healthcare Provider Details

I. General information

NPI: 1720246002
Provider Name (Legal Business Name): JUDY S CHERTOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST 7TH FLOOR
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

51 N 39TH ST 7 FLOOR
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-8777
  • Fax:
Mailing address:
  • Phone: 215-662-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD445488
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD445488
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: