Healthcare Provider Details

I. General information

NPI: 1760598676
Provider Name (Legal Business Name): DEBBIE MARIE BOWEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

947 PROSPECT PL
BROOKLYN NY
11213-1831
US

V. Phone/Fax

Practice location:
  • Phone: 917-797-5076
  • Fax:
Mailing address:
  • Phone: 917-797-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0046291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: