Provider Demographics
NPI:1285057968
Name:ENGLARD, JUDITH BINA (MASTER)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:BINA
Last Name:ENGLARD
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:BINA
Other - Last Name:MANDELBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 54TH ST
Mailing Address - Street 2:3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4258
Mailing Address - Country:US
Mailing Address - Phone:347-404-1457
Mailing Address - Fax:
Practice Address - Street 1:1350 54TH ST
Practice Address - Street 2:3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4258
Practice Address - Country:US
Practice Address - Phone:347-404-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3561228171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator