Provider Demographics
NPI:1861509416
Name:DEBRA HANLEY MD,LLC
Entity Type:Organization
Organization Name:DEBRA HANLEY MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-256-5557
Mailing Address - Street 1:236 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-2006
Mailing Address - Country:US
Mailing Address - Phone:201-933-8703
Mailing Address - Fax:201-933-8705
Practice Address - Street 1:1130 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-3806
Practice Address - Country:US
Practice Address - Phone:973-256-5557
Practice Address - Fax:973-256-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04461000207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082093Medicare ID - Type Unspecified