Provider Demographics
NPI:1427063940
Name:PENEIRAS, DEBRA (ANP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:PENEIRAS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1381
Mailing Address - Country:US
Mailing Address - Phone:732-687-5644
Mailing Address - Fax:732-410-4640
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:STE 231
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2871
Practice Address - Country:US
Practice Address - Phone:732-625-0210
Practice Address - Fax:732-625-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN113734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8499209Medicaid
NJP16131Medicare UPIN
NJ043091Medicare ID - Type Unspecified