Provider Demographics
NPI:1285648469
Name:DEBUCK, STEPHANIE S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:DEBUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRENTWOOD, SUITE A
Mailing Address - Street 2:ORTHOPEDIC SERVICES OF CMA
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-7000
Mailing Address - Fax:607-272-4604
Practice Address - Street 1:16 BRENTWOOD, SUITE A
Practice Address - Street 2:ORTHOPEDIC SERVICES OF CMA
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-272-7000
Practice Address - Fax:607-272-4604
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209083207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959306Medicaid
NY01959306Medicaid
NYH00495Medicare UPIN