Provider Demographics
NPI:1851350847
Name:RODITSKI, DEBRA (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:RODITSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CEDAR LN
Mailing Address - Street 2:208
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4314
Mailing Address - Country:US
Mailing Address - Phone:201-907-0484
Mailing Address - Fax:201-907-0428
Practice Address - Street 1:222 CEDAR LN
Practice Address - Street 2:208
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4314
Practice Address - Country:US
Practice Address - Phone:201-907-0484
Practice Address - Fax:201-907-0428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06266800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP30793Medicare UPIN