Provider Demographics
NPI:1104229517
Name:BUXTON, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BUXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 94TH ST
Mailing Address - Street 2:7N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6999
Mailing Address - Country:US
Mailing Address - Phone:646-251-4119
Mailing Address - Fax:
Practice Address - Street 1:255 W 94TH ST
Practice Address - Street 2:7N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6999
Practice Address - Country:US
Practice Address - Phone:646-251-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY841548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist