MEDICARE: JUDITH LYNN HFA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013063684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH LYNN HFA LLC

Provider Business Mailing Address
First Line	:	1800 WARING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6331
Country	:	US
Telephone Number	:	718-379-4400
Fax Number	:	718-320-2442

Provider Business Practice Location Address
First Line	:	1800 WARING AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6331
Country	:	US
Telephone Number	:	718-379-4400
Fax Number	:	718-320-2442

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MR. MARK LIEBERMAN
Credential	:
Telephone Number	:	718-379-4400

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/22/2020

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