Provider Demographics
NPI:1770641573
Name:DEBORAH R. SPEY, LLC
Entity Type:Organization
Organization Name:DEBORAH R. SPEY, LLC
Other - Org Name:ADVANCED DERMATOLOGY & SKIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-9600
Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-731-9600
Mailing Address - Fax:973-731-1635
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 410
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-731-9600
Practice Address - Fax:973-731-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600098920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089637Medicare ID - Type UnspecifiedGROUP NUMBER