Provider Demographics
NPI:1215929054
Name:ETELSON, DEBRA H (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:H
Last Name:ETELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HUGUENOT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5200
Mailing Address - Country:US
Mailing Address - Phone:914-235-1400
Mailing Address - Fax:914-235-1534
Practice Address - Street 1:145 HUGUENOT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5200
Practice Address - Country:US
Practice Address - Phone:914-235-1400
Practice Address - Fax:914-235-1534
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856633Medicaid
NY9Y0211Medicare PIN
NYG96255Medicare UPIN