Provider Demographics
NPI:1376661306
Name:JONES, DEBRA YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:YVONNE
Last Name:JONES
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 6537
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-0537
Mailing Address - Country:US
Mailing Address - Phone:609-581-5124
Mailing Address - Fax:609-581-5129
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BUILDING C, SUITE 313
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-581-5124
Practice Address - Fax:609-581-5129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05422300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1480103Medicaid
NJE36081Medicare UPIN
NJ1480103Medicaid