Provider Demographics
NPI:1841458437
Name:BULCHA DEBOSSE, SEBLEWONGEL (MD)
Entity type:Individual
Prefix:DR
First Name:SEBLEWONGEL
Middle Name:
Last Name:BULCHA DEBOSSE
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 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR ADMIN
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1600
Mailing Address - Country:US
Mailing Address - Phone:609-653-3265
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:2605 SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2136
Practice Address - Country:US
Practice Address - Phone:609-365-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255018207Q00000X
NJ25MA09289300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0437433Medicaid
NY00695941Medicaid
NY331954Medicare Oscar/Certification
NY00695941Medicaid