Provider Demographics
NPI:1790765949
Name:GOSS, DEBORAH ANNE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE MARIE
Last Name:GOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:170 PROSPECT AVE
Mailing Address - Street 2:EXCELSIOR II, SUITE 20
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1820
Mailing Address - Country:US
Mailing Address - Phone:201-996-0232
Mailing Address - Fax:201-996-0095
Practice Address - Street 1:170 PROSPECT AVE
Practice Address - Street 2:EXCELSIOR II, SUITE 20
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1820
Practice Address - Country:US
Practice Address - Phone:201-996-0232
Practice Address - Fax:201-996-0095
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06851700174400000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH89159Medicare UPIN
NJH89159Medicare UPIN