Provider Demographics
NPI:1609108869
Name:DEBLOCK, DONALD R (MSN, RN-BC, ANP-BC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:DEBLOCK
Suffix:
Gender:M
Credentials:MSN, RN-BC, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1519
Mailing Address - Country:US
Mailing Address - Phone:201-599-0101
Mailing Address - Fax:201-599-3131
Practice Address - Street 1:481 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1519
Practice Address - Country:US
Practice Address - Phone:201-599-0101
Practice Address - Fax:201-599-3131
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00253000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health