Provider Demographics
NPI:1891033635
Name:KORN, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 FRANKLIN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1746
Mailing Address - Country:US
Mailing Address - Phone:877-591-5378
Mailing Address - Fax:
Practice Address - Street 1:521 FRANKLIN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1746
Practice Address - Country:US
Practice Address - Phone:877-591-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00359700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist