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General NPI Number Information
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NPI Number | 1568598274
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Entity Type | Individual
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Provider Name | R.JUDE LIPTAK AUD.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 430 MCLAWS CIR SUITE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5655
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Country | US
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Telephone | 757-229-4004
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Fax | 757-229-9992
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Provider Business Mailing Address
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Address Line | 430 MCLAWS CIR SUITE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5655
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Country | US
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Telephone | 757-229-4004
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Fax | 757-229-9992
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201001149
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License Number State | VA
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