Provider Demographics
NPI:1083949499
Name:COLEMAN, DEBRA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:SLOBOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12023
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5023
Mailing Address - Country:US
Mailing Address - Phone:212-427-2666
Mailing Address - Fax:212-289-6929
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:ANESTHESIOLOGY - BOX 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:800-627-4470
Practice Address - Fax:770-666-9341
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262726163W00000X, 367500000X
NY633563367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001524601Medicare PIN