Provider Demographics
NPI:1386290567
Name:DEBERG ENTERPRISES, LLC
Entity type:Organization
Organization Name:DEBERG ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TADGI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-276-9120
Mailing Address - Street 1:6429 TRANSIT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2206
Mailing Address - Country:US
Mailing Address - Phone:716-276-9120
Mailing Address - Fax:
Practice Address - Street 1:6429 TRANSIT RD STE 1
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2206
Practice Address - Country:US
Practice Address - Phone:716-276-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty