Provider Demographics
NPI:1689615908
Name:SYMONETTE, DEBORRAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORRAH
Middle Name:
Last Name:SYMONETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 EAST 149TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-579-6010
Mailing Address - Fax:718-579-6010
Practice Address - Street 1:234 EAST 149TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-6010
Practice Address - Fax:718-579-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8972207P00000X
NY167951207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169032302Medicaid
TX169032302Medicaid
8D9747Medicare ID - Type Unspecified