1295769396 NPI number — ROBERT H DEBBS DO

Table of content: ROBERT H DEBBS DO (NPI 1295769396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295769396 NPI number — ROBERT H DEBBS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBBS
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295769396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1865 E. ROUTE 70
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-894-0287
Provider Business Mailing Address Fax Number:
856-396-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1865 E. ROUTE 70
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-894-0287
Provider Business Practice Location Address Fax Number:
856-396-3404
Provider Enumeration Date:
07/11/2006

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: 207V00000X , with the licence number:  OS008247L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 25MB05656400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: OS008247L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 25MB05656400 , 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: 001462180 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".