Healthcare Provider Details

I. General information

NPI: 1861509416
Provider Name (Legal Business Name): DEBRA HANLEY MD,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MCBRIDE AVE
WEST PATERSON NJ
07424-3806
US

IV. Provider business mailing address

236 ALDEN ST
WALLINGTON NJ
07057-2006
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-5557
  • Fax: 973-256-5036
Mailing address:
  • Phone: 201-933-8703
  • Fax: 201-933-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA04461000
License Number StateNJ

VIII. Authorized Official

Name: DEBRA HANLEY
Title or Position: OWNER
Credential: MD
Phone: 973-256-5557