Provider Demographics
NPI:1437692308
Name:DEBRIN, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DEBRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254B MOUNTAIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2413
Mailing Address - Country:US
Mailing Address - Phone:908-767-1089
Mailing Address - Fax:908-684-3065
Practice Address - Street 1:254B MOUNTAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2413
Practice Address - Country:US
Practice Address - Phone:908-767-1089
Practice Address - Fax:908-684-3065
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00368900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical