Provider Demographics
NPI:1568512945
Name:MADER, DEBORAH (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MADER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-203-2215
Mailing Address - Fax:212-683-8070
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-203-2215
Practice Address - Fax:212-683-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist