Provider Demographics
NPI:1760546121
Name:KREEL, DEBRA ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ELLEN
Last Name:KREEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:
Practice Address - Street 1:24 BOOKER STREET
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2619
Practice Address - Country:US
Practice Address - Phone:201-822-0100
Practice Address - Fax:201-822-0107
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00374600225100000X
NY010648-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07G91Medicare PIN
NJ176061Medicare PIN