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General NPI Number Information
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NPI Number | 1659056257
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Entity Type | Individual
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Provider Name | JON J JUDY CSFA
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Gender | Male
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 43169 GATWICK SQ
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City | ASHBURN
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State | VA
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Zip | 20147-4432
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Country | US
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Telephone | 623-533-9733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4042
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City | BROADLANDS
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State | VA
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Zip | 20148-0003
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Country | US
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Telephone | 623-533-9733
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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