MEDICARE: DR. JUDY M JUCO MD

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	207Q00000X	Family Medicine Physician	MA034259	NJ

General Provider Information

NPI Number	:	1326113465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY M JUCO MD

Provider Business Mailing Address
First Line	:	95 E MAIN ST
Second Line	:	SUITE106
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2158
Country	:	US
Telephone Number	:	973-586-4111
Fax Number	:	973-586-8466

Provider Business Practice Location Address
First Line	:	95 E MAIN ST
Second Line	:	SUITE106
City	:	DENVILLE
State	:	NJ
Zip	:	07834-2158
Country	:	US
Telephone Number	:	973-586-4111
Fax Number	:	973-586-8466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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