Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | X005168 | NY |
NPI | 1215079819 |
---|---|
Provider Name | Dr. Joseph A. Debe |
First Address | Great Neck, NY 11021-3305 |
Second Address | Great Neck, NY 11021-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T53116 | (02) | NY |