MEDICARE: DEBRA HANLEY MD,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	25MA04461000	NJ

General Provider Information

NPI Number	:	1861509416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA HANLEY MD,LLC

Provider Business Mailing Address
First Line	:	236 ALDEN ST
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-2006
Country	:	US
Telephone Number	:	201-933-8703
Fax Number	:	201-933-8705

Provider Business Practice Location Address
First Line	:	1130 MCBRIDE AVE
Second Line	:
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-3806
Country	:	US
Telephone Number	:	973-256-5557
Fax Number	:	973-256-5036

Authorized Official
Title or Position	:	OWNER
Name	:	DEBRA HANLEY
Credential	:	MD
Telephone Number	:	973-256-5557

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/09/2008

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