1548244015 NPI number — DR. DEBORAH CHANDLER PH.D.

Table of content: DR. DEBORAH CHANDLER PH.D. (NPI 1548244015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548244015 NPI number — DR. DEBORAH CHANDLER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDLER
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1548244015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5197 MAIN STREET
Provider Second Line Business Mailing Address:
POST OFFICE BOX N
Provider Business Mailing Address City Name:
SOUTH FALLSBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12779-2013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-436-5107
Provider Business Mailing Address Fax Number:
845-436-5208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5197 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH FALLSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12779-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-436-5107
Provider Business Practice Location Address Fax Number:
845-436-5208
Provider Enumeration Date:
11/30/2005

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: 103TC0700X , with the licence number:  010922 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY12289 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01282571 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com