Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R119712 | MD |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | R119712 | MD |
NPI | 1013130608 |
---|---|
Provider Name | Ms. Deborah Telem |
First Address | Haverstraw, NY 10927-2105 |
Second Address | Nyack, NY 10960-2407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 26/09/2018 |