Provider Demographics
NPI:1821269952
Name:HOLMBERG, DEBRA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KNOLLWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460
Mailing Address - Country:US
Mailing Address - Phone:973-208-0089
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WAHSINGTON AVENUE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381746363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics