Provider Demographics
NPI:1275673394
Name:DEBRA EPSTEIN, MD, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:DEBRA EPSTEIN, MD, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-234-4436
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-0344
Mailing Address - Country:US
Mailing Address - Phone:856-234-4436
Mailing Address - Fax:856-234-4469
Practice Address - Street 1:1000 S LENOLA RD
Practice Address - Street 2:BUILDING2, SUITE103
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-1630
Practice Address - Country:US
Practice Address - Phone:856-234-4436
Practice Address - Fax:856-234-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400108524207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF30702Medicare UPIN
NJ727110Medicare ID - Type Unspecified