Healthcare Provider Details

I. General information

NPI: 1780755447
Provider Name (Legal Business Name): DEBRA OBRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WHITE RD SUITE D
SHREWSBURY NJ
07702-4039
US

IV. Provider business mailing address

20 WHITE RD SUITE D
SHREWSBURY NJ
07702-4039
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-3400
  • Fax: 732-741-3104
Mailing address:
  • Phone: 732-741-3400
  • Fax: 732-741-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA69550
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06955000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: