Provider Demographics
NPI:1558464073
Name:JOSEFSON, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:JOSEFSON
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 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST STE B120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3059
Practice Address - Country:US
Practice Address - Phone:973-873-7000
Practice Address - Fax:973-743-8943
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064708207R00000X
NE22038207R00000X, 207ZP0101X
VA0101235369207R00000X, 207ZP0101X
AZ33902207R00000X, 207ZP0101X
NY199813207R00000X, 207ZP0101X
NC200501268207R00000X, 207ZP0101X
FLME93911207ZP0101X
IL36112999207ZP0101X
NJ25MA08683400207ZP0101X
NC207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5098922OtherGHI
G96863Medicare UPIN