Provider Demographics
NPI:1962430959
Name:FARENGA, DEBRA ANN (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:FARENGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 205 & 205
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-464-1600
Mailing Address - Fax:315-464-1601
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:STE 205 & 205
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-464-1600
Practice Address - Fax:315-464-1601
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301386363LA2200X
NYF333162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01857318Medicaid
NYP60382Medicare UPIN
NY01857318Medicaid
NYJ400001391Medicare PIN
NYJ400141281Medicare PIN
NYRB3960Medicare PIN