Provider Demographics
NPI:1619008844
Name:KLUGMAN, DEBORAH M (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:KLUGMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CABRINI BLVD APT 4L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3643
Mailing Address - Country:US
Mailing Address - Phone:212-781-3147
Mailing Address - Fax:
Practice Address - Street 1:622 WEST 168 STREET VC2
Practice Address - Street 2:VC 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-6355
Practice Address - Fax:212-305-6279
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92N281Medicare ID - Type UnspecifiedPROVIDER NUMBER