Provider Demographics
NPI:1285727479
Name:HERRMANN, DEBORA L (MA,PT)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:L
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MA,PT
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,PT
Mailing Address - Street 1:30 MILBURN DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-2265
Mailing Address - Country:US
Mailing Address - Phone:908-281-7047
Mailing Address - Fax:908-281-7049
Practice Address - Street 1:1877 OCEAN AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6867
Practice Address - Country:US
Practice Address - Phone:718-258-2737
Practice Address - Fax:718-258-2737
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7045225100000X
NJQA04588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54051Medicare ID - Type Unspecified