Healthcare Provider Details

I. General information

NPI: 1043953417
Provider Name (Legal Business Name): DEANNA EGENBURG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 COUNTY ROAD 520 STE B201
MARLBORO NJ
07746-1187
US

IV. Provider business mailing address

479 COUNTY ROAD 520 STE B201
MARLBORO NJ
07746-1187
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-2619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12845500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: