=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568427441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY R ANDERSON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2006
-----------------------------------------------------
Last Update Date | 11/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 984 N BROADWAY #310
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-963-0010
-----------------------------------------------------
Fax | 914-963-8406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 FIREMENS MEMORIAL DR STE 115
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10970-3569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-963-0010
-----------------------------------------------------
Fax | 914-963-8406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 202419
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------