Healthcare Provider Details

I. General information

NPI: 1619054855
Provider Name (Legal Business Name): DEBORAH ANN MOERCK-JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 LONG BEACH RD
ISLAND PARK NY
11558-1510
US

IV. Provider business mailing address

312 LONG BEACH RD
ISLAND PARK NY
11558-1510
US

V. Phone/Fax

Practice location:
  • Phone: 516-897-5000
  • Fax: 516-431-7519
Mailing address:
  • Phone: 516-897-5000
  • Fax: 516-431-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number217654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: