Provider Demographics
NPI:1528166956
Name:ARCHER, JUDITH MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 EAST 49TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2105
Mailing Address - Country:US
Mailing Address - Phone:718-377-2628
Mailing Address - Fax:718-677-9855
Practice Address - Street 1:5TH AVE & 100TH ST
Practice Address - Street 2:MOUNT SINAI HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3042951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner