Provider Demographics
NPI:1811661564
Name:DEBARIM INC
Entity type:Organization
Organization Name:DEBARIM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-464-0050
Mailing Address - Street 1:21874 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2166
Mailing Address - Country:US
Mailing Address - Phone:718-464-0050
Mailing Address - Fax:718-464-0045
Practice Address - Street 1:21874 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2166
Practice Address - Country:US
Practice Address - Phone:718-464-0050
Practice Address - Fax:718-464-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038965OtherLICENSE