Provider Demographics
NPI:1952472045
Name:ESERNIO-JENSSEN, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ESERNIO-JENSSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:17TH & CHEW
Practice Address - Street 2:CHILDREN'S CLINIC - CHILD ADVOCACY
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105-7017
Practice Address - Country:US
Practice Address - Phone:484-633-0934
Practice Address - Fax:484-862-3138
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158449208000000X
FLME106764208000000X
PAMD452408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002141600Medicaid
FL002141600Medicaid