Provider Demographics
NPI:1124088760
Name:DEB, ASHOKE K (MD)
Entity type:Individual
Prefix:
First Name:ASHOKE
Middle Name:K
Last Name:DEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:390 N BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1253
Practice Address - Country:US
Practice Address - Phone:856-678-6411
Practice Address - Fax:856-678-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059636L207R00000X
NJ25MA06471700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG36104Medicare UPIN
NJ892462TNIMedicare ID - Type Unspecified