Provider Demographics
NPI:1003096215
Name:DEBROCI, ZSUZSA (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:ZSUZSA
Middle Name:
Last Name:DEBROCI
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRISTEL RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2717
Mailing Address - Country:US
Mailing Address - Phone:917-686-6669
Mailing Address - Fax:
Practice Address - Street 1:761 PALMER AVE
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1086
Practice Address - Country:US
Practice Address - Phone:917-686-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 003566171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQZ18503CMedicaid