Healthcare Provider Details

I. General information

NPI: 1194738203
Provider Name (Legal Business Name): LORRAINE FRANCIS DEPASS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CHURCH ST STE 4
BOUND BROOK NJ
08805-1743
US

IV. Provider business mailing address

515 CHURCH ST STE 4
BOUND BROOK NJ
08805-1743
US

V. Phone/Fax

Practice location:
  • Phone: 908-218-1121
  • Fax: 908-253-9031
Mailing address:
  • Phone: 908-218-1121
  • Fax: 908-253-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA65356
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: