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General NPI Number Information
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NPI Number | 1225916612
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Entity Type | Individual
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Provider Name | MICHAEL JUDGE
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Gender | Male
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 998 CROOKED HILL RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-1019
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Country | US
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Telephone | 631-521-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 29 OCEAN AVE APT 3
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City | ISLIP
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State | NY
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Zip | 11751-3814
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Country | US
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Telephone | 516-557-3150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37470
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License Number State | NY
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