Provider Demographics
NPI:1184676231
Name:BISACCIA, DEBRA MARIE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MARIE
Last Name:BISACCIA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STONE PLACE
Mailing Address - Street 2:STE 307
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-337-8300
Mailing Address - Fax:914-337-8884
Practice Address - Street 1:1 STONE PL STE 307
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3427
Practice Address - Country:US
Practice Address - Phone:914-337-8300
Practice Address - Fax:914-337-8884
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018539-1225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQD4751Medicare PIN
NYQD475Q45K1Medicare PIN