Provider Demographics
NPI:1326076589
Name:DEBBI, EILEEN S (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:S
Last Name:DEBBI
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 1:164-05 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4140
Mailing Address - Country:US
Mailing Address - Phone:718-297-6090
Mailing Address - Fax:718-297-6094
Practice Address - Street 1:164-05 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4140
Practice Address - Country:US
Practice Address - Phone:718-297-6090
Practice Address - Fax:718-297-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1696372081P2900X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04346Medicare ID - Type Unspecified
NY04346GMedicare PIN
NYE87558Medicare UPIN
NY79F783Medicare PIN