Provider Demographics
NPI:1619044674
Name:WADDELL, DEBORAH (DIPL AC CA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:WADDELL
Suffix:
Gender:F
Credentials:DIPL AC CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 EAST MILL RD
Mailing Address - Street 2:SUITE 2 209
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853
Mailing Address - Country:US
Mailing Address - Phone:908-876-3643
Mailing Address - Fax:908-876-3136
Practice Address - Street 1:59 EAST MILL RD
Practice Address - Street 2:SUITE 2 209
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853
Practice Address - Country:US
Practice Address - Phone:908-876-3643
Practice Address - Fax:908-876-3136
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ000020900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist