1932112133 NPI number — DEBORAH GRACE SCHNURR MD

Table of content: DEBORAH GRACE SCHNURR MD (NPI 1932112133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932112133 NPI number — DEBORAH GRACE SCHNURR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNURR
Provider First Name:
DEBORAH
Provider Middle Name:
GRACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PECORA SCHNURR
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932112133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 FRANKLIN AVE
Provider Second Line Business Mailing Address:
STE 410
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-751-6610
Provider Business Mailing Address Fax Number:
973-759-1155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-751-6610
Provider Business Practice Location Address Fax Number:
973-759-1155
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA05810700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5410401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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