Provider Demographics
NPI:1225049588
Name:ANDRUSCHKEVICH, DEBRA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:ANDRUSCHKEVICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1611
Mailing Address - Country:US
Mailing Address - Phone:856-464-8685
Mailing Address - Fax:
Practice Address - Street 1:575 FOX RUN RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4242
Practice Address - Country:US
Practice Address - Phone:856-232-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000506002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer