Provider Demographics
NPI:1154520047
Name:FRUCHTMAN, DEBORAH S (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:FRUCHTMAN
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 1:11 RAPPLEYE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2194
Mailing Address - Country:US
Mailing Address - Phone:973-736-4564
Mailing Address - Fax:
Practice Address - Street 1:11 RAPPLEYE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2194
Practice Address - Country:US
Practice Address - Phone:973-736-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04688600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology