Provider Demographics
NPI:1629727524
Name:WAJSBAUM, DEBBY
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:
Last Name:WAJSBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBBY
Other - Middle Name:
Other - Last Name:WALKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 KIRYAS SANZ AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6164
Mailing Address - Country:US
Mailing Address - Phone:134-753-3037
Mailing Address - Fax:
Practice Address - Street 1:406 KIRYAS SANZ AVE BSMT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6164
Practice Address - Country:US
Practice Address - Phone:347-533-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program