Provider Demographics
NPI:1710325097
Name:DAVIDSON, DEBORAH
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 1ST ST APT 303
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3368
Mailing Address - Country:US
Mailing Address - Phone:646-600-3068
Mailing Address - Fax:
Practice Address - Street 1:207 1ST ST APT 303
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3368
Practice Address - Country:US
Practice Address - Phone:646-600-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date: