Provider Demographics
NPI:1184735128
Name:ANKELEIN, DEBORAH JEAN (BA,MS, ATC)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:JEAN
Last Name:ANKELEIN
Suffix:
Gender:F
Credentials:BA,MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAINES LN
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9617
Mailing Address - Country:US
Mailing Address - Phone:201-281-9138
Mailing Address - Fax:
Practice Address - Street 1:94 BROWN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2018
Practice Address - Country:US
Practice Address - Phone:973-790-7909
Practice Address - Fax:973-790-3536
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000751002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer