Provider Demographics
NPI:1831156819
Name:GOLDSON-PROPHETE, DEBRA N (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:N
Last Name:GOLDSON-PROPHETE
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 1:20 VALLEY ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079
Mailing Address - Country:US
Mailing Address - Phone:973-313-1113
Mailing Address - Fax:973-313-1191
Practice Address - Street 1:20 VALLEY ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079
Practice Address - Country:US
Practice Address - Phone:973-313-1113
Practice Address - Fax:973-313-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07114700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine